"An Interview with Steven Bratman
Author of "Health Food Junkies"
by Frederic Patenaude
Steven Bratman, M.D. is a Colorado-licensed physician and a national-level expert on alternative medicine. In 1997, Dr. Bratman coined the term "orthorexia nervosa" to describe a condition he'd seen in some of his patients: obsession with healthy diet to such an extent that it seemed to him like an eating disorder. To go to Steven website, click here.
What is orthorexia?
I used to be in practice as an alternative medicine doctor, and I was frequently called upon to advise people about ways to improve their diets. In alternative medicine, we consider that healing by diet is superior to using other sorts of treatments. Theres the statement from Thomas Edison, The doctor of the future will give no medicine, but will interest his patients in the care of the human body, in diet, and in the cause and prevention of disease. So the notion is that youre supposed to do it and thats superior to drugs.
But I started to have so many patients coming to me with their interest in diet where it seemed that it had gotten to the point of being a little bit insane. From a holistic point of view, I began to question whether it was a side-effect-free treatment to tell people to entirely remake the way that they eat and to eat in such a way that theyre separated from most of the rest of the world. That might be justified, but thats an enormous side-effect its gigantic. Somehow, alternative medicine got the idea that eating only for health rather than for pleasure makes completely good sense. Ive always taken that for granted, but then I began thinking about it with these poor people I was seeing who basically had turned their lives into a menu, rather than a life. And I was thinking, Its a horrible side-effect. You shouldnt be spending most of your life thinking about what you should be eating. If you compare a drug, say, that gives you dry mouth, which would be considered a horrible side effect, having to give up everything you love eating is a much bigger side-effect. So that was part of it. I was seeing these patients and realized that what they really needed from me was to be detoxed from their dietary theories. And theres a way of doing that. I decided to invent a word, to sort of tease people with it. Because usually people who are on a diet are very proud of it and feel that theyre virtuous, and good, and even better than other people because they do it. So to tease them, I decided to make it sound like its an illness. So I came up with the word orthorexia, which is just parallel to anorexia. Ortho means righteous, or right. So orthorexia would be righteous eating.
Its only later after I wrote the book that I began to discover that it has more relationship to anorexia than I thought. In fact, some people do starve themselves to death with it. I hadnt really thought about that, I thought that this was more cute really, and just a way of teasing people who are health-food junkies But now Ive decided that it probably is an eating disorder for some people.
What is the right diet?
Theres a zillion of these diets, and they all contradict each other. Raw-foodism says you should eat everything raw, Macrobiotics says you should eat nothing raw. Chinese medicine considers raw foods to be the cause of cancer and arthritis. Youve got fool allergy theories, theres the Zone, theres an endless number of these dietary theories. You and I can just make up a dietary theory right now and if we pushed it seriously enough, people would be following. There are two dietary theories I will not mention that were invented in cold blood by people just to make money. People will believe anything. Theres the theory, its complicated enough, its individualized enough, it has some philosophy attached to it. People get all exited and decide they should follow it. So you have people on the Zone, or Eat Right for Your Type, or any of those things, and they believe that doing this thing will help them. But what possible evidence could there be that a certain diet is good for you? Suppose you want to determine if diet X is good for you, how would you do that?
If a person just wants to eat healthier... isnt that okay to want to do that?
But what is eating healthier? How would you know that a certain way of eating is eating healthier? Ill grant you that its pretty reasonable that eating lots of fruits and vegetables is healthier. But how do we know that anything in particular is healthier than another, how would you know that? Suppose you wanted to see whether macrobiotics was healthier than raw-foodism, how would you do that? They completely contradict each other. Other than just saying so, based on your intuition. How would you decide?
Maybe based on the results?
How would you do the results? You have to look at it scientifically, otherwise all you have is testimonials. In other words, macrobiotics will give you lots of testimonials of people who get cancer and heart disease after going on a raw-food diet. Raw-food people can tell you lot of anecdotes of people who eat nothing but cooked food and get really sick. You can tell anecdotes for anything you want. Anecdotes mean nothing. To know if something works, you have to do a formal study. Now suppose you did a formal study of people for maybe 5-10 years some of them eating raw foods, some of them eating macrobiotic. That would work if they werent allowed to choose which diet they followed, so its randomized. Then you would have some meaningful evidence at the end of the study whether one was better than the other. But even that would be very limited evidence, because people would be doing better than others depending on how well they believed on what they were doing. So its almost impossible to actually come up with evidence to show that one diet is better than another. Its even hard to conceive of how to do it, and therefore everything becomes simply statements.
(Comments by Frédéric: Bottom line: you can't be absolutely sure that a certain diet is the best thing on the planet. It probably isn't the case.)
Diet as a Religion
In your book you compare raw-foodism to a religion, why is that?
All these diets are like religions really. Basically, a severe diet is kitchen spirituality. Its religion translated into the form of food. Thats the motivating factor. People get all the religious feelings about it. They think that theyre doing the right thing, that theyre being noble and they are superior to other people .They get so guilty whenever they fall off the diet and they get to redeem themselves by getting back on. They get to do what I call food purism, which is the sense that if you give up something that you like, it gives you a psychological value of reward. And it gives you the emotional sense that youre doing a virtuous thing. So I think its like religion, except that its religion in a particularly narrow, materialistic way: food. So this is religion centered on food which is a very small thing.
What are the psychological reasons that would make people want to go on these extreme diets in the first place?
I think its what I just said. It makes you feel like you have your life under control. You cant really know if you control life, but you can control your eating. So doing that gives you a psychological satisfaction that youre doing something good. You get to feel virtuous and you get to feel better than other people. You get to have the feeling that youre insuring your health. I think those are the reasons why people go on diets, plus the fact that people have the desire to find the one right way. Its much more relaxing to imagine that you hit on the one right way. People love that.
Different degrees of orthorexia
Do you think that many people who follow alternative diets eventually end up becoming orthorexic?
I think most people dont. For most people who are on alternative diets, its like a hobby or a lifestyle choice. Its like being interested in skiing, rock climbing, or liking to read books. There are a few people though, particularly in raw-foodism, whose extremism can make them unhealthy or even lead them to death. I know of a couple dozens of cases. A few women, but far more men than women, which is weird.
(Comments by Frederic: I think that being interested in health and nutrition is quite valuable. However, it's when it turns into an obsession that it's not healthy.)
How can someone die of orthorexia?
They starve themselves. In my website I mentioned the case of Kate Finn, who got her weight down to 58 pounds. There are a lot of raw-food people who are pretty emaciated. Raw-foodists will also go very bad on the protein part, meaning they wont eat enough protein. Of course you can eat enough protein on that diet, but many of them wont. There are not very many cases of people who die from that, though. Its pretty rare. But before I wrote the book I had no idea it even happened at all. And now I see that it does. And every single one of these that Ive heard about were raw-foodists, with one exception.
How can you tell if someone is orthorexic?
Now that Im taking this more seriously, I would say that if your weight is particularly low, youre probably dangerously orthorexic, or you have anorexia, or something like that. Personally, I think that anyone who spends more than a few hours a day worrying about food is obsessed. There are much better and more human things to do with ones life than to be absorbed in food. Its a perfectly valid hobby, but when it starts to get to the point where its really ruining your life, when youre thinking about it most of the time, its like work alcoholism. Youre giving one part of your life far too much attention. No matter what you do, youre going to die. So keeping yourself healthy is worthwhile to some extent. But if youre beginning to occupy your life so what youre living for is simply to be healthy to live, thats like sort of going in circle.
If you are really finding that its one of the major things youre thinking about in your life, youre orthorexic in kind of the mildest sense. Its not dangerous, but its a little bit minimizing. Its allowing one aspect of your to overdominate it. And thats actually a sad thing.
There are also people who are obsessed not just with diet, but with every aspect of healthy living.
I would say thats rather tragic. Its a tragic waste of a life to live in that way. Thats how I would describe it. Its just like somebody spending 70 hours a week working on their job. They like working all the time, but still, theyre missing out a lot. You want to tell them to have a life, not just work. Its the same thing with people who are obsessed with healthy living. Yeah, live healthy, spend some amount of your time thinking about it, enjoy yourself, and then try to live! Like I say somewhere in my book, theres not a single person who at the end of their life said, The one thing I regret about my life is that I ate too much unhealthy food. Or that I had too much fun, or that I wasnt strict enough with myself. It isnt what people say at the end of their life. They say, I wish Id loved more, or I wish Id lived more, or I wish Id been more creative and more spontaneous and more alive, and that I had valued the moments more. Not that I wish Id been stricter with myself about following health food instructions.
What would be the psychological repercussions of a diet that isolates a person socially?
Social isolation, in most cases, is a problem. If youre being socially isolated to create great works of art, or to advance spiritually or something, you might have a redeemed value. But if youre being socially isolated to eat certain foods, thats an embarrassment. Its an inhuman thing to do. Its a lessening of oneself as a human being, to be reducing oneself to a menu rather than a life. ... People feel they cant be with other people and they also start feeling theyre superior to other people they get really involved in that when theyre on a strict diet.
Is orthorexia a modern thing? How did it happen that people became so concerned about healthy living?
I dont think its that modern. I think there have always been hypochondriacs of one sort or another. And you can say that orthorexia is really a hypochondriac thing. Somebody who is overfocused on certain health issues. There have been theories about diet as long as there has been civilization. The Egyptians had certain theories about diets, so people have always been doing this. Raw-foodism certainly goes back to naturopathy, which began in the early 19th century. So this is that early. There were people doing that quite a while ago. Gandhi was at some point eating only fruits and nuts. So I dont think its new. Its something that people are into right now, but they have been at other times also.
What to do
What do you think an orthorexic person should do, if that person realizes that he or she has a problem with food obsession?
If you have a problem in a mild way, where youre just spending too much time on it, I would just encourage the person to lighten up, and realize that food shouldnt take more than a certain percentage of a persons life. If a person has orthorexia in a severe sense, where theyre loosing weight to the point where its dangerous, then they really need to see an eating disorder specialist. The problem is an eating disorder specialist will generally assume that what you have is anorexia, and that what you want to do is be thin. But the orthorexic person will say, No I dont, I want to be pure, I dont want to be thin. And eating disorder specialist will say, Youre in denial, you want to be thin! And in fact, the orthorexic is correct. They dont want to be thin, they want to be pure. Sometimes you can perhaps convince your eating disorder specialist that you believe this, but in any case, if youre 20% under the minimum weight standards for your height, youre in dangerous, serious physical illness, and you need to gain weight. Its okay to be at the bottom of the weight standards, but if you get below that, you really are not healthy, and its actually a form of self-torture of self-destruction.
You mentioned that all of the deaths that youve seen in orthorexic people were in raw-foodists, except one. Why do you think that this problem is much more extreme in raw-foodism?
Well, it might not be. It could be simply because my articles are up on www.beyondveg.com, and so raw-food people get in touch with me. It might not be more common in raw-foodists. It might just be the people I happen to hear of. You have to do it scientifically to find out. I havent done it, so I dont know for sure.
What would be your message to people who are reading this article and maybe are realizing that they may have gone a bit too far with food obsession?
I think that the main thing is to just lighten up. Theres a bunch of bumper stickers that say something like, Life is too short to drink bad wine, or some variation on the theme. The bumper sticker that I would make would say something like, Life is too short to spend it obsessing about diet.
From the book "Health Food Junkies"
To see if you have orthorexia, answer the following questions, and give yourself one point for each "yes" answer.
1. Do you spend more than three hours a day thinking about healthy food? (For four hours, give yourself two points.)
2. Do you plan tomorrow's food today?
3. Do you care more about the virtue of what you eat than the pleasure you receive from eating it?
4. Have you found that as the quality of your diet has increased, the quality of your life has correspondingly diminished?
5. Do you keep getting stricter with yourself?
6. Do you sacrifice experiences you once enjoyed to eat the food you believe is right?
7. Do you feel an increased sense of self-esteem when you are eating healthy food? Do you look down on others who don't?
8. Do you feel guilt or self-loathing when you eat food you like, but isn't on your diet?
9. Does your diet socially isolate you?
10. When you are eating the way you are "supposed" to, do you feel a peaceful sense of total control?
If your points add up to more than four, you may have orthorexia nervosa.
Note: if your search for dietary purity has led you to become seriously underweight, you definitely have an eating disorder, either the anorexic form of orthorexia, or a hidden form of anorexia. In either case, consultation with an eating disorders specialist may be life saving.
FINAL COMMENTS BY FREDERIC: As I have mentionned before, food disorders are very prevalent in raw food and vegan movements. I think that Stephen Bratman explains this issue very well. There is more to life than just food! I'm also very concerned about people going downhill with their health, thinking that they are doing the right thing.It's often hard to explain to them that they need to change their approach.
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