By Men’s Health Magazine
Ref Nigel Owens had bulimia for 27 years.
He may be better-known than half the players he mediates for, but international referee Nigel Owens isn’t without his share of demons. The rugby legend admitted this weekend to a 27-year long battle with bulimia nervosa, a statement that took a considerable amount of courage.
He’s not alone. Eating disorders hit even the rich and powerful, with bulimia alone affecting musicians like Elton John and Justin Hawkins, comedians like Russell Brand and politicians like John Prescott. Is it time we rethought how we, as a nation, view what’s on our plates?
Up to a massive 42% of Britons are on clean-eating diets, according to a new report by Neilson. While we might consider this a job well done, the inner workings of the data are slightly more sinister, with entire food groups like dairy and gluten being cut out of diets across the country. One MH staffer tells us how clean-eating got the better of him, transforming into an unhealthy relationship with food. We chart his journey through Orthorexia.
“Go on, mate. One piece won’t kill you.”
The words fill me with anxiety. Without a single forkful passing my lips, I can already taste the cloying guilt at the back of my throat. While everyone else tucks into their second slice of wedding cake, washed down with champagne, I stay soberingly hungry. Because where they see soft vanilla sponge layered with fresh fruit jam and buttery, melt-in-the-mouth icing, all I see is a toxic slice of gluten topped with 50g of gut-rotting sugar.
(Related: can you lose weight by relaxing the sugar rules?)
I haven’t eaten all night. The starter: too salty. The chicken: dripping with a fatty sauce. The bread rolls: where do I start? I push the cake around on my plate, and long for the comfort of the Tupperware boxes occupying every inch of my fridge at home. The initial superiority I felt, as I smugly watched my friends stuff their faces with high-GI carbs, has waned. And as the night goes on, I consider that maybe the big fat joke is on me after all.
It began with the best intentions – an inter-office fitness challenge that called for a healthier diet. I cut out the foods I knew to be bad for me. But three months in and it’s out of hand. Dining out is off the menu; the pub is a no-go zone; even weddings, like tonight’s, simply result in an imperfect marriage of food and stress. My rules were meant to make me feel better; I look good, but feel much worse. And while I’m getting props in the weights room, I’m one unhappy gym bunny.
An unhealthy obsession with healthy eating: it sounds like a contradiction in terms – the least of our worries in a nation of swelling obesity rates. How can cutting out all the bad stuff ever be harmful? It repudiates the most basic principles of bro science. And yet psychologists and dietitians agree that this may well be the most wide-reaching, if least understood, dietary health concern affecting us today.
According to the experts, sufferers are most likely to be in their 30s, health-conscious and well-educated. For heavily filtered evidence, just scroll through your Instagram feed: hashtags like #eatclean and #fitfood abound, through which millions of users unashamedly share their photographs of joyless – borderline inedible – meals to gain validatory likes from strangers. This is but one symptom of a most modern eating disorder: orthorexia. If you’ve ever experienced an anxious twisting in your stomach after eating a cheese sandwich, or declined a dinner invitation on account of its impact on your “gains”, you may well be afflicted.
(Related: how #fitspiration may be hurting you)
Doubtful? Ask yourself this: when you’re planning dinner, do you care more about the nutritional makeup of your meal than the taste? Do you have a mental blacklist of foods that you crave but won’t touch? Does the thought of risking your friend’s trademark spag bol fill you with unease (for the carb content, rather than their overzealous seasoning)?
If, like me, you answered yes to any of these questions, then what began as a desire to look after your body may have mutated into something more insidious. Though our expanding waistlines and related health issues steal the headlines, just as many of us are subject to forces of equal and opposite severity. “I would say that, in this country, orthorexia affects hundreds of thousands of people – maybe millions,” says Deanne Jade, psychologist and principal of the National Centre for Eating Disorders. “The problem is growing because it’s become socially acceptable – cool, even – to eat a quirky diet.”
This quirkiness takes many guises, but all have one thing at their core: restriction. The paleo diet – no grains, legumes or dairy – is one culprit. But so is removing gluten or processed foods. Cutting foods from your diet on a whim is hazardous, not so much for the impact on your body as on your mental health. Like all eating disorders, orthorexia nervosa – to give it its full title – is primarily a problem of the mind. Case in point: a gym acquaintance recently attributed his underperformance on the bench to the BPA in food packets. Not, you know, the fact that he hadn’t eaten carbs in three weeks. That doesn’t exactly scream ‘healthy body, healthy mind’.
(Related: how stress changes your brain)
Unlike most eating disorders, it is people like him, you and me who are most at risk – men, essentially, but especially those with an interest in fitness. Men who let their food go cold while they search the calories in MyFitnessPal or walk up and down the stairs to beat yesterday’s step count. “Both sexes are susceptible for different reasons,” says Ursula Philpot, chair of the British Dietetic Association’s mental health group, “but men can get hooked on rules and regulations, and numbers and gadgets, very easily.”
So you might be orthorexic, but the question remains: how can eating a diet consisting exclusively of healthy foods be bad for you? And if it is, where’s the line? Well, if you’re trying to pick one out of a crowd, the orthorexic is the man with the rippling six-pack and guilty conscience. “Given the choice, I’d rather not eat McDonald’s,” says Jade. “But if it was the only thing available, I would. Whereas someone with orthorexia would have a great sense of anxiety. They would feel poisoned when it’s inside them.”
The restrictive eater: Thomas Grainger, 21, student
When I was younger I was overweight. I absorbed as much information as I could about healthy eating and exercise, and I managed to lose the weight. But I quickly found that I started to become obsessive. I restricted anything that I believed caused inflammation in the body. So I had no sugar, no gluten and no dairy. I even used to refer to them as poisons. If I knew that I was going to be around food of that nature, I would eat before, or eat afterward. The only time I was comfortable was when I was cooking on my own. Even the process of shopping at the supermarket became exhausting, as I’d read the labels on everything to check the food didn’t have added sugars, genetically modified ingredients or plant-based oils.
I became evangelistic and tried to put these ideas in other people’s minds too. Eventually, they didn’t want to cook for me because they thought that I’d judge them. I became the ‘health freak’ guy. My weight kept dropping. I started to develop real health complications. I was later diagnosed with inflammatory bowel disease. My body just couldn’t cope with the stress that I was putting it under. It was only when I made the decision to eat more flexibly that I managed finally to find a truly healthy, balanced diet.
This acute guilt is something I know all too well. During my challenge, I would warm up one of my five pre-prepped daily meals every three hours. Combined, these met the precise daily macronutrient requirements that I’d calculated would give me visible abs (195g of protein, 240g of carbs, 80g of fat, if you’re interested). My evenings were spent meticulously weighing ingredients for the next day’s meals. There was no leeway. Deviation resulted in guilt-induced insomnia and eye-rolling from an understandably unsympathetic girlfriend.
Gluten was out. So too dairy, sugar and booze. In fact, soon the list of restrictions was so long that eating with friends became a genuine source of stress. What if they forgot I couldn’t have cheese? What if I succumbed to temptation and did something truly deplorable like eat a potato? It was either take my Tupperware with me, or take myself home. Physically, I was in the best shape of my life, but emotionally I was a wreck. I had become so obsessed with controlling my diet that I was constantly thinking about food. In other words, I had become orthorexic.
(Related: turns out potatoes aren’t all that bad)
“Orthorexia begins when healthy eating starts to interfere with ordinary life,” says Philpot. “At Christmas, birthdays and weddings, people will eat certain sorts of food. If you can’t join in because your healthy eating is such that you can’t enjoy social occasions, go out for meals or socialise with other people, that is when it becomes problematic. When nutrition starts to become a larger chunk of your life and you start spending a disproportionate amount of your time planning and researching it, that’s when we start to worry. It becomes obsessional.”
I turn to Russell Delderfield, researcher at the University of Bradford, who is studying eating disorders in men. How could my aspiration to make positive changes have turned into a burgeoning eating disorder? How can the ability to deadlift most grown men be rooted in an unhealthy mentality? After all, I tell him, it all started as a push to get my body into the best shape of my life. But the damage, he says, started the moment I let my dietary decisions spill over into my relationships. “You begin to withdraw from people because you can’t eat with them; they can’t prepare food the way that you need it prepared; they can’t offer you the kinds of foods that you find acceptable. It even goes to the point of behaviours that you normally associate with anorexia, such as hiding food and disposing of it later, or avoiding any situation where there’s exposure to unacceptable foods. That to me is more than just being on a fitness drive.”
Delderfield was right. I was becoming alienated from my friends. And who could blame them? I certainly wouldn’t want to hang out with me. Psychologically, food dominated my thoughts and had a strangle hold on my emotional state. That much I was starting to come to terms with. But nutritionally, it was hard to see why I should stop feeding myself what I deemed to be a healthy diet. What was the physical harm? Anorexics can starve themselves to death; bulimics can do permanent damage to their internal organs. My diet, neurotic though it might sound, was ultimately healthy. Wasn’t it?
The self-flagellator: Jamie Millar, 31, MH writer
It was in the second year of university, when I moved out of catered college accommodation and into a rented house, that I first became entirely responsible for feeding myself. I had full control over my diet; I could make it ‘optimal’. So I started getting anal with portion control, counting calories and weighing out carbs. I lost body fat; I also lost muscle mass and power on the football pitch. There’s a photo of me on Facebook in fancy dress as Bruce Lee and you can count my ribs. Eventually I regained some weight, but only because I was feeling unhappy with my body. It took my first serious relationship, with my now-wife, to make me realise that eating a can of tuna with sweetcorn for dinner is not healthy, whatever its macros. Even now, I tend to mentally lump days into ‘good’ and ‘bad’. If a lapse of willpower turns the former into the latter, all bets are off until tomorrow, when I’ll wake up feeling guilty – and probably early, so I can train it off. But with my wife’s help, I’ve become more relaxed. I’m happier in myself. And I’ve at least learned not to ask how many grams of rice she’s cooked.
The term orthorexia was coined almost 20 years ago by American doctor Steven Bratman, who was also the first person diagnosed with the condition. Bratman, moved by the scientific literature that was starting to emerge about the impacts of certain foods, decided to go on a health kick and made a concerted effort to let only nutritionally beneficial foods pass his lips. The more he read, the more he cut out, until he realised his diet had become so restrictive that he was actually – to his surprise – causing physical harm. His healthy diet had started to make him sick.
“People think they’re taking these squeaky-clean roads,” says California-based Alan Aragon, the self-proclaimed Ron Burgundy of nutrition. “But there are things they’re doing in terms of their food choices that are actually less nutritious than if they were being more flexible with what they ate, by which I mean including so-called ‘naughty’ foods.” The problem, says Aragon, who has seen a dramatic rise in cases of orthorexia among gym-going men, stems partly from the bad language we use to talk about food.
“Labels such as ‘clean’ and ‘dirty’ automatically make people judge individual foods outside of the context of the rest of their diet. If your diet is rigid and inflexible, with a very strict ‘avoid’ list of foods, and a very narrow ‘approved’ list, you could be missing out on good nutrition from the foods you mistakenly feel are bad.” Single ingredients aren’t in themselves good or bad, he says. The way they fit into your diet is what counts. “There is such a thing as a dirty diet, but individual foods being dirty? No, because you can’t look at anything in isolation from the wider context.” Not even a Twix.
To the orthorexic mind, the notions of ‘healthy food’ and ‘healthy diet’ have become conflated. Dangerously so. Everyone knows that kale, for example, is good for you, but try to survive on a kale-only diet and you’ll live a miserable, emaciated (and short) existence. The key to health and happiness does not lie in the leaves of a cruciferous vegetable. This, on a wider scale, is where the obsession with healthy food – rather than a healthy diet – becomes physically destructive. As the list of foods you can eat gets shorter, as your diet becomes more restricted and your rules more devoutly observed, you miss out on essential nutrients your body requires in order to achieve balance.
It’s something psychologist Jade sees all too often in her clinics. “When I work with people who have orthorexia,” she says, “part of my job is to try and get them to start eating some of the foods that they forbid themselves, and the terror is just enormous.” Don’t believe her? Try telling a long-time paleo devotee they need to eat a lasagne for their own good. “But they need to do so because some of them are deeply malnourished. They’re restricting their diets, they’re not getting enough nutrients, their body is under stress, and that, clearly, is not healthy.”
(Related: are paleo diets dangerous?)
The paleo dieter: Adib Bamieh, 34, director of Pure Taste restaurant
I went paleo five years ago. I’d been sleeping poorly and feeling uncomfortable and just assumed it was normal. I quit sugar, gluten and dairy and noticed the change fast. I started to push myself harder with training too. I was netting minus 500 calories a day with exercises compared to how much I ate. It all got out of hard. I was working in the City. There’s was a drinking culture, so I used to lie and say I was on medication so couldn’t have any alcohol. At business conferences that served food, I’d bring my own or just not eat. I was obsessed. Today I still eat paleo – I run a paleo restaurant – but I’m less strict. I went to Milan recently and had pizza. Because as long as you’re not slamming your body with toxins, it’ll cope. You just need get it right 80% of the time.
Make a clean break
At the root of the problem is the constant message that it’s our unhealthy food choices that are killing us. Obesity is on the rise, as are diabetes and heart disease, all of which have their roots in our diets. Everyone from the NHS to nutritionists insists that in order to protect ourselves we need to think more carefully about our food choices. After all, goji berries may be expensive, but the cost is negligible compared to the £16bn that obesity and diabetes are jointly estimated to cost the NHS each year.
(Related: goji berries? Here’s 6 less expensive superfoods)
In this context, it’s not surprising that orthorexia is growing at such a pace. Isn’t it only natural – inevitable, even – that people will begin to obsess over what goes into their shopping baskets? “We, as a society, have lost our balance,” says Jade. “Orthorexia has become normalised. The message that permeates is that if you’re eating ‘normally’, then you’re not taking proper care of yourself. People wear their ‘clean’ eating habits like a badge of pride. And anxious people who don’t feel in control, who swallow it whole, so to speak, become orthorexic by stealth.” Anxious people with a #fitspo-dominated timeline like mine.
For months, I obsessed over the minutest details of my food plan. After that, I couldn’t just go back to ‘normal’. Not only did I not want to – I’d worked too hard for my newly carved-out abs – but I’d forgotten what normal was. This is typical of people who micromanage their nutrition, says Aragon. “Once you’ve been lean, and you know what was necessary to achieve that, it can be very difficult to think of doing anything else,” he says.
In other words, I had overhauled my unhealthy habits, but replaced them with a set of psychologically and potentially physically damaging new ones. I knew that my relationship with food wasn’t healthy. That it was disordered. But still, if I ‘slipped up’ by having a couple of pints with my friends, or ‘cheated’ by ordering dessert, I was racked with guilt.
The thing is, I still want to be healthy. I don’t just want to stuff my face with all the buttery, sugary cakes that come my way. I was only just getting to know my abs – it seems a shame to wave them goodbye, with a family-size bag of crisps in hand. So how can I commit to a wholesome diet without compounding my unhealthy obsessions? I ask Aragon for his advice. “Don’t try to micromanage it,” he tells me. “You can never track everything down to the most minute detail, and by trying to do so, you lose the big picture. You can’t see the forest for the trees. Try to eat predominantly whole and unprocessed food, but build in a margin of flexibility. Realise that if 10, or even 20% of your diet comes from junk, you can still live a long and healthy life”.
The challenge now is to learn to enjoy food for what it is, rather than solely the macronutrients it provides. And not to set rules, but create guidelines. “Getting into a routine is fine,” says Aragon. “Just get into a routine that you like.”
So I’ve developed a new routine. It involves eating an apple in the afternoon, despite its high sugar content. Drinking a pint, or four, on a Friday night. Saturday too, maybe. And only posting pictures of food on social media that tastes as good as it looks. Because that’s healthy for me. And that is the kind of behaviour I’m looking forward to obsessing over.