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Photograph by George Sakkestad

What's Eating Them? Doctor Steven Bratman says 'orthorexia nervosa' refers to a fixation on eating healthy food.

Consuming Passions

Navigating the fine line between healthy eating and obsession, one reformed health food junkie is urging other dietary extremists to get a life, not just a menu

By Mary Spicuzza

HE ASKED if I was a musician or an artist.

My answer not only horrified him, but helped us both quickly decide that I was not the person to fill the empty room for rent in his West Side Santa Cruz household.

"I like to cook," I answered, quite unprepared for the outrage my hobby would inspire.

His face twisted with disgust as he vividly explained how the wonderful smells wafting from my pots and pans while cooking were all of the vitamins and nutrients being sucked out of the ingredients. He described what was left behind, my homemade creation, as nothing more than "a toxic soup."

"That's why I'm on a raw foods diet," he said proudly, adding that his housemate was into raw foodism as well. He admitted, with clear disapproval, that she had a weakness for cooked pasta, and said my fondness for preparing Italian dishes made me an especially poor candidate for the room.

Even before he began swinging from what appeared to be pull-up bars attached to the ceiling--insisting that "most people don't play enough"--I knew our future living together was grim. I had to excuse myself and, regardless of the scarcity of housing, let that one get away.

Author Dr. Steven Bratman, a medical doctor and acupuncturist, confesses that he gave similar speeches to countless friends and family during his years as a macrobiotic, vegan (vegetarian who eats no eggs, dairy or animal products) raw foods follower--to name just a few of his dietary habits. Others included chewing each morsel of food 50 times and making it a rule never to eat a vegetable more than 15 minutes after picked. Now, in his new book, Health Food Junkies: Overcoming the Obsession with Healthful Eating, Bratman creates the term "orthorexia nervosa" as a label for those who push interest in normally healthy foods to dangerous extremes. As one who was also "seduced" by righteous eating but escaped from the damaging addiction, he wants to help others trapped by orthorexia.

"There have always been recommendations regarding the healthiest food to eat, but in recent decades the obsession over healthy eating seems to have escalated out of control. In more and more people it seems to be taking on the characteristics of an eating disorder like anorexia or bulimia," Bratman writes in the introduction to his book. "However, unlike these other eating disorders, orthorexia disguises itself as a virtue."

He acknowledges that all vegetarians and vegans are not obsessive, and that eating low on the food chain can be extremely healthy. Still, Bratman warns against pushing restrictive diets to extremes.

"It's not that I don't support eating healthy food," he says. "It's only that when healthy eating becomes an obsession, it's no longer healthy."

Unlike other addictions and their complicated 12 steps, Bratman offers three stages in his book to recovering from orthorexia--admitting the problem, understanding the causes and learning to eat without obsession. Basically he urges readers to get a life, not just a menu.

[line]

Pure Celebrity: Some random food requirements of the stars.

Orthorexia Self-Test: Dr. Bratman has created a 10-question quiz to determine whether a person's relationship to health food is a virtue or a vice.

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The Vice of Virtue

DOCTOR BRATMAN has enough horror stories to compete with any doctor who has worked with junkies trying to get clean. One of his patients, a raw-foodist who limited her diet to only include fruits and vegetables, fainted so frequently from protein deficiency that he decided to hospitalize her. She avoided being admitted to the hospital by vowing to eat protein-rich nuts and legumes, only to crash her car into a storefront and die a few days later.

"She is believed to have fainted while driving," Bratman says.

He tells of another woman, also a strict raw-foodist, who died in a hotel room while hiding out from the friends who were trying to put her in the hospital. Then there's the man who allowed his child to drink just four ounces of water a day so as not to over-hydrate, and created a state of severe dehydration for the boy.

Bratman acknowledges that such extreme, sensational cases are rare, and may overlap with other eating disorders such as anorexia.

"Usually orthorexia won't kill you. Its harm lies in what it does to your mind and spirit," he warns, "the way it creates a distorted and unhealthy view of life."

"Ortho" comes from the Greek, meaning straight, correct or true.

He writes, "Orthorexia nervosa refers to a fixation on eating healthy food."

Bratman hasn't done clinical tests or studies, but insists he isn't trying to create a medical disorder that would belittle the serious problems involved with other eating disorders. "I invented the word orthorexia as a tease. I don't really believe it's as bad as anorexia, but the word has shock value to get people to reexamine their values," Bratman says during a telephone interview from his home office in Fort Collins, Colo. "It's like workaholism. Nobody thinks it's as bad as alcoholism. But like workaholism, people mistake it as a virtue."

And no one can deny that people become passionate about food. Bratman says he recently got an email from someone, married to a vegan, whose spouse is divorcing her for eating meat. He says that for many people healthy eating goes beyond just what they personally choose to consume. For some it's a lifestyle or an identity. The problem lies in when it grows into orthorexia, an obsession. Bratman witnessed orthorexia while living in Santa Cruz, but says that the phenomenon extends far beyond Santa Cruz and the Bay Area. "There's a huge raw foods movement in New York right now," he says, adding that even the music magazine Spin has done articles about raw foods.

Local acupuncturist and Chinese doctor Martha Benedict says that she hasn't read Health Food Junkies and isn't sure if the diets he describes are on the rise. However, she admits that she has treated patients that fit the orthorexic description.

"I think people use food inappropriately, and obsession is a common thing if you are emotionally starved," she says. "It's a safe obsession, compared with heroin addiction. But if they are looking for spiritual fulfillment in the refrigerator, they're not going to find it. I see a lot of it, but I'm in a position that I would see a lot of it. People come to me when they're having problems."

Even those who aren't working in alternative health care say that signs of devotion to health food are cropping up in their daily lives, even if they aren't the ones suffering from orthorexia.

Rebecca D'Madeiros worked in Santa Cruz natural foods stores for years before taking a job as a health food shop manager in Portland, Ore. She says that at times it was difficult to meet the needs of Santa Cruz shoppers, rattling off examples of patrons who refused to let the food they were purchasing touch paper or be microwaved, or those who grew extremely upset if their lunch was wrapped in to-go packaging. D'Madeiros also recalls how difficult it was to answer detailed questions about the types of vinegars and spices used in preparing dishes. But she says the most extreme case involves a woman who shops at the Portland store.

"She preys on every part of the store. She'll talk to produce [people] for at least a half-hour each time she comes in, usually about the stickers used, the packaging, where the fruit was grown. And the stickers we use on our produce are organic," D'Madeiros says. "Her food religion goes beyond the food itself."

D'Madeiros adds that she herself is not a mainstream, meat-and-potatoes type. She is mostly vegetarian and avoids shopping or eating where organic produce and free-range dairy aren't available. But she doesn't feel her diet is at the same intensity level as her persistent shopper.

D'Madeiros says, "For her, it's a lifetime, an obsession. She's there for two to three hours on each shopping trip."

Blame It on the Grain

ONE CHEF AT A LOCAL natural foods store says that she's watched shoppers comb the shop with everything from crystals--checking the life force of foods--to Geiger counters. She declines to be identified for the story, for fear of offending customers, and adds that she's become "as paranoid as anybody" as she reads the newspapers about the current state of American food processing.

Yet she doesn't embark on a quest for total food purity as actively as some. Hannah Prunty remembers having the healthiest of intentions when she became a vegetarian in her early 20s. After she and her boyfriend decided to adopt a vegan diet, she says her energy levels and confidence in the quality of her food were better than ever before. But her then boyfriend began showing warning signs of what Bratman would call orthorexia. Never satisfied that his diet would be pure enough, he began getting upset at Prunty when she would eat dairy products on occasion. He became even stricter, adopting a fruitarian diet--only eating fruits so as not to kill any entire plants for food.

"He eventually lost over 30 pounds and looked like a skeleton," Prunty says. "These diets were all about cleansing your body and he just believed them all. His friends and family were calling me, begging me to make him eat. He felt sick but thought it was only because his body was going through a cleansing process. I think he just lost touch with reality," Prunty says. "His fruitarianism became all about control, control over his body, what and when he ate. I think it was his way of feeling powerful in his life. I once wrote in my journal about eating cookies and he read it and got upset with me because he wanted me to be 'healthy,' too."

When they tried to intervene and hospitalize him, he insisted the diets weren't at fault for his illness. Prunty eventually broke up with her fruitarian partner and doesn't know much about the current state of his health or his diet. She is married to a nonfruitarian and living in San Diego.

Bratman says that the reasons for episodes like the fruitarian's meltdown aren't usually about food, but involve a number of hidden causes. In his book he lists a series of issues, including an attempt to create an illusion of total safety, a desire for complete control, covert conformity, searching for spirituality in the kitchen, food puritanism, creating an identity, and fear of other people.

Martha Benedict says that part of the intensity of food stems from the gaps it fills in modern society. "We are a spiritually bereft nation. An emotionally starved nation. A materialistically oriented nation. Other parts of our psyche are given short shrift," Benedict says, soon adding, "since food is something we rarely go without, it's really easy to make it an object of obsession."

She adds that experimenting with diet needn't be a dangerous thing and may just be part of anyone learning more about personal identity.

"Some people try different diets as a form of coming to who they are," she says.

Yet for others, like Wiley Brooks, founder of the Breatharian Institute of America, what you eat can also lead to an identity crisis. After professing the health benefits of fasting and living on pure air, Brooks was allegedly caught leaving a 7-Eleven store munching on a hot dog and sucking down a Slurpee.

While interviewing him about a possible new product, Fresh Liquid Air in a Bottle, I asked him about the incident. He quickly explained that the air is less pure in the city and he is used to clean mountain air.

He says, "So sometimes I need to take some food." Brooks did not return recent calls from Metro.

Mary Foley
You Are What You Think: Mary Foley, an educator for the Santa Clara Valley Public Health Department's nutrition and wellness unit, says having a healthy attitude toward eating is as important as the choices made.

Pyramid Scheme

MARY FOLEY SHOWS UP for our interview armed with copies of the suggested food pyramid and statistics showing the grim reality of the American diet. An educator for the Santa Clara Valley Public Health Department's nutrition and wellness unit, Foley hasn't dealt much with orthorexia. She spends most of her time trying to break east San Jose families of their fast-food addictions, urging them to rediscover unprocessed foods like fruits and vegetables. She points to statistics that show that less than 30 percent of Californians reported eating five servings of fruits and vegetables a day in 1998, and 38 percent of those surveyed reported that they are trying to lose weight. A more recent study, from 2001, found that 60 percent of adult Americans and up to 15 percent of children are overweight or obese.

"A vegetarian diet can be a very healthy way of eating. It is a plant-based diet, which is the base of our food pyramid," Foley says. Gone are the days when the health department pushed the four basic food groups. Foley now supplies information and brochures produced by the Vegetarian Resource Group about well-balanced vegetarian and vegan diets. Even the Journal of the American Dietetic Association (June 2001) printed two studies detailing how children and even infants can be raised on healthy, thoughtfully planned vegan diets.

Foley says she has read portions of Bratman's Health Food Junkies and agrees that obsession is probably not a good dietary foundation.

"Eating healthy foods isn't enough. It's also having a healthy attitude toward eating," she says. "You should be consuming your food; it shouldn't be consuming you."

Still, at the state health department's headquarters in Sacramento, it doesn't sound like cancer prevention nutrition specialist Dan Scott is ready to declare an orthorexia state of emergency.

Scott says, "I think it's the least of our problems."

Buddhists and Big Macs

DR. BRATMAN SAYS that one of his patients tried diet after diet, but she kept getting a reoccurring infection. After months of not seeing her, she finally reported back that she had cured herself with a "beer and pizza diet."

She happily reported no problems, insisting, "Loosening up on food is what cured me."

Bratman came to a similar realization when he decided, like another friend, that "rather than eat my sprouts alone, it would be better for me to share a pizza with some friends."

The reformed health food junkie adds that while working at a nursing home, few people on their deathbeds were worried about eating too much ice cream or not enough kale.

People like Michelle Oppen don't see any conflict between veganism and leading a healthy social life. Oppen, a 28-year-old mostly vegan living in Sacramento, says she doesn't see herself as an extremist at all.

"Dairy doesn't really agree with me and I don't feel I was meant to eat animals. But I think I support everyone choosing what to eat for themselves," she says. "I'm not preaching, and encourage people to eat whatever they feel comfortable with."

Oppen says that while mainstream America seems to be growing more tolerant of her diet, she often encounters confusion over her vegan requests.

"I was in Florida recently for a conference and I went to get pizza and ordered it without cheese," Oppen says. "The waitress had a hard time comprehending that and said she didn't know what to put on it without cheese."

Oppen does confess to a sense of guilt when eating processed foods or having something with dairy in it, a type of guilt, or lack thereof, that Bratman addresses in one memorable story of his book. He tells in detail of the time the Karmapa, an important figure in Tibetan Buddhism, came to visit a Santa Cruz Buddhist household. Residents of the devout home, on Belmont Street near Highway 1, went to great pains to prepare a whole-grain vegan lunch complete with fresh-pressed carrot juice, only to have it waved away when the Karmapa arrived. According to the translator, the now-deceased Karmapa wanted to go to the Santa Cruz Beach Boardwalk before eating. After a spin on the roller coaster and driving the bumper cars, the Karmapa made another announcement that shocked his vegan entourage.

"This man, this Karmapa, believed to be an embodiment of wisdom and a fount of understanding, capable of miracles on earth and of consciously reincarnating after death, this divine figure asked to go to McDonald's."

Bratman recounts, "It appeared that he was inordinately fond of Big Macs."

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From the August 2-8, 2001 issue of Metro, Silicon Valley's Weekly Newspaper.

Copyright © 2001 Metro Publishing Inc. Metroactive is affiliated with the Boulevards Network.

For more information about the San Jose/Silicon Valley area, visit sanjose.com.




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