How To Heal From Orthorexia, Part 2: Orthorexia in Chronic Illness - Where Health is a Legitimised Obsession
Last week, I discussed the process of identifying whether your health “habits” may be creeping towards being health obsessions - and how to uncover the reasons behind why this might be.
But if you are reading this website then it is highly likely that you, or someone close to you, is currently dealing with some form of chronic illness. In this situation the whole landscape of wellness is entirely different. The lines between what is an appropriate level of attention and what is obsessive and damaging can become blurred.
In fact, for those who have a chronic illness it is sometimes impossible to draw a line between the right level of attention on health practices to ensure wellbeing - and an obsessive avoidance of everything that might cause a downturn in wellbeing.
This article is going to cover this very specific niche: where health pursuits in those who have been diagnosed with a chronic illness become suffocating.
This is happening more and more in my practice, and it is something that concerns me. I know and believe in the value and the power of health practices and healthful nutrition for wellbeing, I also know the damaging impact that stress - and more importantly, fear - can have on a health journey.
The most common place for this fear to take root is in the realm of nutrition, the potential “damage” of so many different foods/eating styles is loudly promoted. The modern internet turns nutrition into a pitch-battle, and, as such, staying healthy, particularly when suffering from an illness, seems to require encyclopaedic knowledge and a dietary straight jacket.
Within chronic illness a greater-than-normal degree of attentiveness towards what is healthful may be warranted. However, all too often I see that staying healthy has become an oppressive, overwhelming and stressful pursuit - and as such is actually cosetting people in isolation where they do very little and eat very few foods - all through the fear of the consequences.
I do want to state up front that I feel it is absolutely normal to develop a certain degree of paranoia around health practices when you are suffering from a chronic illness. In fact, I think it’s odd if people who have become unwell AREN’T slightly obsessed by improving their health.
However, the challenge comes when the scope of “what is healthy” becomes an utterly all-encompassing list of things, places, experiences, situations and foods that you must AVOID in order to ‘stay well’.
I see this regularly in my clinic, particularly when it comes to dietary restrictions. Attempting to be as healthy as they can be, clients can arrive at my door combining multiple restrictive diets, eating just a handful of foods and consequently practically starving themselves. And I know this storyline, because it is part of my history. When my own conditions were undiagnosed (and even once they were) I was promised that the route to healing was through nutrition. Whilst this has an element of truth - it is only part of the story.
Recognising that nutrition (and healthful ‘practices’ themselves) are only part of the story is the first step to changing your relationship to wellness from one of obsession to one of surrender.
ORTHOREXIA IN CHRONIC ILLNESS: UNDERSTANDING THE FEAR
To tackle fears, the first step is to really isolate what they are - and name them.
Throughout the rest of this article I am going to focus on the orthorexic restrictive mindset when it is focused on food, because this is what I see most often and is what, in my experience, is the most damaging obsession because food obsessions literally dominate lives and affect every decision.
However, everything outlined below can be applied to other health behaviours such as the fearful avoidance of certain situations, pursuit of specific workouts or exercise regimens, hygiene habits or toxin avoidances based on the conviction that all these things cause symptom flares or fuel illness.
Within Orthorexia the fear is of the CONSEQUENCES of deviating from templates and rules for health.
When it comes to food, whether my clients have studied the anti-nutrients, inflammatory potential and indigestibility of foods and have eliminated them based on information, or they have witnessed their own reactivity to certain things and so are avoiding everything they’ve ever reacted to - the end result is a dietary wasteland in which only a few foods are deemed ‘safe’.
Dietary restriction is chosen because it is promoted as ‘healthy’. In reality, the end result (and the paranoia that it creates) is anything BUT healthy.
To understand how this fear grows, we must recognise that the fear is not actually about the food - it is projected onto the food. The fear is that the food creates reactions and a downturn in wellbeing. Food can easily (particularly in the modern environment where everyone seems to be a citizen scientist when it comes to nutrition) become associated with different outcomes.The reality of nutrition is that the categories of ‘good’ and ‘bad’ are never really able to be applied: there is just appropriate nutrition, at an appropriate level, for each individual. However, this nuance becomes lost in an attempt to commercialise programs or ‘diets’. Let’s face it ‘good’ and ‘bad’ is easier to discuss.
But when we do discuss foods in this way, it makes it seem like there is a ‘right’ and a ‘wrong’ way to eat. Here is where doing only what is ‘right’ can become a driving force in someone’s life. Attaching to ‘health’ is a route out of illness - and tension and stress about only ever doing the ‘right thing’ follows.
From a state of heightened tension and dietary restriction, my clients are absolutely correct when they state that they don’t ‘tolerate’ any more than their limited repertoire. This reactivity occurs for a host of reasons, most importantly because their digestive enzymes and microbiome are un-used to digesting what they have for so long eliminated, and also because their psyche and nervous system are completely unprepared for anything new.
In fact, when we are programmed (by society, by the internet, by the health and wellness world etc) to think of foods and life situations as bad for us and threatening, our psyche and nervous system become prepped to fight anything that comes towards us.
Unfortunately, living in such a state WILL create reactions. Whilst the reaction is borne out of the state of the person receiving the food, we instead attach the reaction to the food itself.
This reinforces the belief that those foods are damaging and poorly tolerated. These experiences build an evidence base which corroborates our suspicion - that to stay well we must avoid a catalogue of foods (and experiences, situations etc.)
CHRONIC ILLNESS AND THE QUESTION OF SAFETY
The reason all of this becomes an easy trap for those dealing with chronic illness is because when our bodies fail they automatically start to feel unsafe. When we feel insecure and under threat within our own skin, clinging onto an external framework which suggests that it will provide safety is incredibly attractive.
This is what therapeutic and healing diets (such as Paleo, AIP, Veganism, Macrobiotics, Raw Foodism etc.) do: they provide an allure of ‘safety’ and an attraction towards the promise of reducing reactions and empowering healing. To anyone with an illness these diets seem like saviours.
Though I am rarely this specific about my work, the underlying bedrock of what I am doing with each of my clients is hoping to provide them with a safety and a security within their own skin again. What provides this level of safety for each client will be different - but the universal, underlying principle behind what I do is my belief that everyone has the right to feel at home in their own skin and know how to nourish and nurture themselves optimally.
The danger - even in my work - is that when a dietary solution is presented which provides a peace and a relief from symptoms and pain it is natural to associate restrictions with safety. But whilst temporary avoidance of certain foods can be a useful therapeutic tool, complete avoidance of all stressors is really not a long term strategy for overall wellbeing. Eventually the ‘safety blankets’ of avoidance that we build to cope with our lives end up creating stress and actually becoming damaging and, in themselves, unsafe.
It is my view that the art of finding physiological safety is part of the healing process, but it is not the whole healing process. And this is where the Orthorexia component comes in. If you have to live like a monk to stay ‘healthy’ then whilst this might feel safe, it is actually a lifestyle predicated upon fear. As such, it cannot be truly comfortable - and you have not found comfort in your body, you have found a tension through which you are just about coping with life, providing you stay within tramlines.
Whilst it would be nice if this worked, living in fear of facing unknowns or stepping out of safety parameters has real, neurological impacts. It is because of these impacts that I always state that whilst food is an important part of health, it is not the most important part of wellbeing. It may provide the foundations - but mindset, perspective and the motivation behind your actions is vitally important.
Our mindset can circumvent the benefit of even the healthiest food by putting us on high alert. In high alert the sympathetic nervous system is active and this decreases the digestive function across the board: reducing motility, breakdown and absorption of nutrients and increasing the immune activity inside and surrounding the gastrointestinal tract. In such a state food will cause reactions.
Our perspective that everything is a threat will ensure that our approach to life is predicated on anxiety and fear. Decisions then become motivated by fear of consequences or the inner self-perspective that you are inherently vulnerable and need to stay protected by avoiding whole swathes of life experience.
This negative self-perspective creates an enormous amount of trauma. It is inherently distrusting of oneself, one’s body and the world around you. Having this as a core belief changes the neurology and physiology of the body directly. How this affects people will differ depending on a host of genetic and epigenetic factors. However, living in fear and distrust does not resolve stress: in fact it adds imperceptible stressors to the body. In this state, full health is actually impossible.
SO HOW DO YOU HEAL FROM ORTHOREXIA?
Healing from an orthorexic mindset whilst dealing with a chronic illness really does starts with understanding the above: that a perfectionist, fear-based attitude and perspective on life is creating such stress that health is impossible. For some, this realisation is enough to persuade them to let go of their fixations.
For others, however, the fear of certain foods or situations is so ingrained and tied up with a host of experiential memories of food reactions and symptom flares that simply ‘knowing’ that their health obsession is unwise is not enough.
In this situation, the key to challenging the hold of Orthorexia is to take things very, very slowly.
Recovering from any form of disordered eating is never just about deciding to change. Instead, it is a process of persuading a mind that finds safety in rules and restrictions that these very rules are NOT necessary to remain safe.
This is less about convincing ourselves that the rules create illness - and much more about showing ourselves, experientially, that rules aren’t necessary to maintain health.
In order to do this, there are several important steps. Each one of these could take up an entire article in and of itself, so I will be brief. When I work with my clients who are struggling with opening up their food worlds, or their health horizons, these are the steps we work through together… again, and I must stress this: SLOWLY.
Mindfulness
This is all the rage now - meditation, mindfulness etc. But instead of getting lost in the spiritual, mystical or ‘hard’ meditation options, the main thing that I need my clients to do is just pause.
When food obsessions have taken hold, so much of the way we deal with the eating experience is through tension. Bodies tense, breath is held, the entire physiology is braced against an impact. And all you’re going to do is sit down and eat a meal.
Moreover, when your brain has been filled with a lot of information about certain foods it becomes easy to decide on avoidance based on what someone has told you, rather than how you feel. If you’re locked in tension you are completely unable to feel how you feel. In this situation, the rules can become attractive because you have basically become divorced from the ability to judge how your own body feels when eating a food.
Whilst this might not be as relevant for those on AIP regimens where they are trying to regulate auto-antibodies, it is certainly true for those following low-FODMAP or low-Histamine diets. I have lost count of the amount of clients I see who are religiously avoiding a high-FODMAP food that they have never experienced issues with.
By pausing before you eat a meal you have the chance to breathe, to observe how you feel, to slow your heart rate and to actually unwind the sympathetic stress response. Encouraging a really present state whilst you’re eating is an important foundation for the rest of the process.
Within this pause, you can tune in to how you feel. You do not have to change it, the first step is just to notice it. If you feel the stress building, identify it and just notice it.
Reduce Non-Food-Specific Stress
Within this, I am talking about everything that you are stressing about that has absolutely nothing to do with your food:
If you are worried about work, if you are fighting with your partner, if you are terribly lonely or if you never get any time to just do nothing - work on this first.
If you have nutritional deficiencies (get them tested, don’t guess) then fix this using supplementation, at least in the interim.
If you have traumas and somatic experiences ingrained within your physiology that you choose to ignore or not talk about - find some way to process them (with a friend, therapist, coach, counsellor, family member etc.).
If you have fears, shame, guilt, emotions and anxieties that you haven’t expressed to someone and you feel you should… say them.
The reason for all of this is entirely physiological. If you are in a state where you are getting countless reactions to all kinds of foods then you are likely to be in a state of generalised inflammation (see below for more on this). Whilst in a state of low-grade, permanent inflammation, making changes to diet and changing our mindset around food is relatively challenging (and Step 4 is completely impossible) because every time we eat we prove our suspicions right - we struggle with foods.
Because when we are under chronic stress we cannot (yet) directly tackle food and nutrition, we must tackle every other stress that is contributing to the health picture. And this includes all of the above. Reducing every other stressor gives us more capacity, bandwidth and power to tackle the stress we hold around food and food avoidance.
3. Making Yourself Comfortable With the Consequences
As discussed above, the fear at the root of Orthorexia, and disordered eating in general, is the fear of the consequences of eating off-plan.
For those with Orthorexia in chronic illness the consequences can seem catastrophic because unhealthy food/behaviours have become linked to worsening health outcomes. Moreover, the propaganda machines would have you believe that going ‘off-plan’ will completely ruin your body.
This is simply untrue. Whilst there are exceptional cases such as serious food allergies and coeliac disease, for the majority of people oppressive dietary restrictions are borne out of an attempt to re-regulate a biology and biochemistry that was broken down as a result of countless, cumulative stressors over a considerable length of time.
The best way to understand that you don’t die when you eat something that you have avoided through fear is to actually try it (see step 4). However, in order to calm your nervous and immune system enough to trial foods without excessive adrenaline responses you first need to understand and intellectually grasp the truth about the elimination diets which are promoted to resolve ill health.
The allure of dietary restriction is because it actually works. We feel relief and in light of this we associate pain and distress with the foods we have cut out.
In order to move forwards, it is important to that the catalogue of foods you now avoid actually weren’t the problem.
Nutritional intake is contributive to chronic illness, not causative (again, we are not talking about coeliac/allergies - we are talking here of autoimmunity, chronic fatigue, chronic illnesses, digestive conditions etc.)
Dietary restriction, therefore, is therapeutic, not curative.
This means that eliminating inflammatory foods whilst in a chronically inflamed state can contribute to the reduction of the overall inflammatory load. This provides symptomatic relief but is just like taking a medication in that it is designed to resolve the symptoms. It is only in rare cases that the foods (all of the foods that you are eliminating) are the problem.
Because we don’t know precisely what each person is going to react to AND because background stress in chronic illness is so high, the first intervention must be overly restrictive. However, once the generalised inflammation drops it is no longer necessary or appropriate to remain in an elimination diet of extremes.
Unfortunately, because mindset can up-regulate the stress response and increase the generalised background stress, if you are at all anxious about eating a certain food you are likely to react to it.
What is called for, then, is to understand the following:
a) previous reactivity was based on the state of dysregulation you were in and may not happen every time you consume that food
b) any reactivity is a symptom but it is not a full regression. One experience in which things go a little ‘wrong’ (i.e. reactive) does not mean you are back at square one. A hiccup for anyone is just that, a hiccup - and do not believe any dietary propaganda which tells you otherwise
c) lastly, you have had multiple reactions and hiccups before. Whilst the consequences are not pleasant, you are equipped to deal with them - you have experienced them already.
This last point is about decreasing the fear of the consequences. We can’t always guarantee that step 1 and 2 will bring down the reactivity. However, if you take the catastrophising out of the conceptualisation of the consequences it reduces the amount of control that fearing those consequences has over you.
All of the above steps mean that you pause and take a deep breath, clear the stressors in your life and minimise inflammatory contributors… and then you can take your meal as an experiment in which you cannot really fail and even if you do, you trust that you will be fine anyway.
Because Orthorexia is there to keep you ‘safe’ from something - if you change your perspective on what is threatening (i.e. decreasing the threat of having a reaction to a food) then you reduce the powerful hold an orthorexic mindset can have over you.
Eating can become ‘let’s see what happens’ rather than “I know this food is an ‘x’ and contains ‘y’ so ‘z’ is likely to happen….” and then the fear of a predicted (but unproven) outcome holds all of the power.
Which brings us onto the final step:
Building New Experiential Memories
The main part of recovering from Orthorexia is to let go of, or at least loosen, the boundaries within which you feel ‘safe’.
Whether your strict health behaviours are because deviation from them has previously created flares, or because a textbook has told you what is ‘healthy’ and you are following it to the letter - what really trumps both of these is personal experience of consuming a food without consequences.
By implementing the above steps you are in the best place possible to receive food, and your verdict on what happens as a result is detached. This is an experiment.
From this place, re-educating both your body and brain in the knowledge of what is actually safe - for YOU, not because a textbook says so - is a process of witnessing yourself cope with more and more foods. As you slowly introduce foods and notice no reactions, an interesting thing happens in your mind: you start to realise that there aren’t as many threats as you thought, and somehow needing to stay ‘safe’ loses priority.
In chronic illness healing from Orthorexic attitudes isn’t just about telling your mind all the reasons why Orthorexia isn’t healthy, or all the explanations of science regarding how certain foods are fine for you. It’s not an intellectual understanding that is required, or a processing of something internally that makes you hold onto the health obsessions.
Instead, within chronic illness, healing from an orthorexic attitude is much more of a journey to calm the body’s immune and nervous systems and decrease stress - and then, from this place, prove to yourself that the security blankets of avoidance and restriction are not only not necessary - but they actually make being healthy harder.
If you can prove, before your own eyes, that your body copes admirably with things you were avoiding through fear, you unlock yourself from thinking that the only way you can be, and stay, healthy is through adopting an obsession with it.
If you, or someone you know, is struggling with all of the things you are trying to ‘do’ in order to stay well, or feel that health is your full-time job and permanent preoccupation, do reach out to me. I myself have navigated the path of finding a balance between attention to nutrition/wellbeing and trusting my body enough to let it show me what health means for me. I have coached many clients in how to find their way along this path and would be delighted to help you do the same.