"Health Food Junkie", the article from the September/October issue of the
Yoga Journal, is so witty and well-written that it deserves to be read in
full. I consider the article a tribute to Tom Billings, Ward Nicholson and
Kirt Nieft who with their tireless efforts have helped respectively raw
foods, natural hygiene and instincto move out of the shadows of the rigid
denial of blind idealism into the light and credibility of flexible and
pragmatic realism.

Best, Peter
[log in to unmask]

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Obsession with dietary perfection can sometimes do more harm than good,
says one who has been there.  By Steven Bratmen, M.D.

Twenty years ago I was a wholehearted, impassioned advocate of healing
through food.  In those days I was a cook and organic farmer at a large
commune in upstate New York.  Today, as a physician who practices
alternative medicine, I still almost always recommend dietary improvements
to my patients.  How could I not?  A low-fat, semivegetarian diet helps
prevent nearly all major illnesses, and more focused dietary interventions
can dramatically improve specific health problems.  But I'm no longer the
true believer in nutritional medicine I used to be.
Where once I was enthusiastically evangelical, I've grown cautious.  I can
no longer console myself with the hope that one day a universal theory of
eating will be discovered that can match people with the diets right for
them.  And I no longer have
faith that dietary therapy is a uniformly wholesome intervention.  I have
come to regard it as I do drug therapy: as a useful treatment with serious
potential side effects.
My disillusionment began in the old days at the commune.  As staff cook I
was required to prepare several separate meals at once to satisfy the
insistent and conflicting demands of our members.  All communes attract
idealists; ours attracted food idealists. On a daily basis I encountered
the chaos of contradictory nutritional theories.
Our main entree was always vegetarian, but a vocal subgroup insisted we
serve meat.  Since many vegetarians would not eat from pots and pans
contaminated by fleshly vibrations, the meat had to be cooked in a separate
kitchen.
We cooks also had to satisfy the vegans, who eschewed all milk and egg
products. The rights of the Hindu-influenced crowd couldn't be neglected
either.  They insisted we omit the onion-family foods which, they believed,
provoked sexual desire.
For the raw foodists we always laid out trays of sliced raw vegetables, but
the macrobiotics adherents looked at these offerings with disgust.  They
would only eat cooked vegetables.  Furthermore, they believed that only
local, in-season vegetables should be eaten, which led to frequent and
violent arguments about whether the commune should spend its money on
lettuce in January.
After watching these foods wars for a while, I began to fantasize about
writing a cookbook for eating theorists.  Each food would come complete
with a citation from one system or authority claiming it to be the most
divine edible ever created; a second reference, from an opposing view,
would damn it as the worst pestilence one human being ever fed to another.
Finding examples wouldn't be difficult. I could pit the rules of various
food theories against each other: Spicy food is bad; cayenne peppers are
health-promoting.  Fasting on oranges is healthy; citrus fruits are too
acidic. Milk is good only for young cows (and pasteurized milk is even
worse); boiled milk is the food of the gods.  Fermented foods, such as
sauerkraut, are essentially rotten; fermented foods aid digestion.  Sweets
are bad; honey is nature's most perfect food.  Fruits are the ideal food;
fruit causes candida. Vinegar is a poison; apple cider vinegar cures most
illnesses. Proteins should not be combined with starches; aduki beans and
brown rice should always be cooked together.
Dietary methods of healing are often offered in the name of holism, one of
the strongest ideals of alternative medicine.  No doubt alternative health
practioners are compensating for the historical failure of modern medicine
to take dietary treatment seriously.  But by focusing single-mindedly on
diet, such practitioners end up advocating a form of medicine lacking in
holistic perspective as the more traditional approaches they attempt to
correct.  It would be far more holistic to try to understand other elements
in the patient's life before making dietary recommendations, and
occasionally to temper those recommendations with that understanding.

Orthorexia Nervosa.

Many of the most unbalanced people I have ever met are those who have
devoted themselves to healthy eating.  In fact, I believe some of them have
actually contracted a novel eating disorder for which I have coined the
name "orthorexia nervosa."  The term uses "ortho," meaning straight,
correct, and true, to modify "anorexia nervosa."  Orthorexia nervosa refers
to a pathological fixation of eating proper food.
Orthorexia begins, innocently enough, as a desire to overcome chronic
illness or to improve general health.  But because it requires considerable
willpower to adopt a diet that differs radically from the food habits of
childhood and the surrounding culture, few accomplish the change
gracefully.  Most must resort to an iron self-discipline bolstered by a
hefty dose of superiority over those who eat junk food.  Over time, what to
eat, how much, and the consequences of dietary indiscretion come to occupy
a greater and greater proportion of the orthorexic's day.
The act of eating pure food begins to carry pseudospiritual connotations.
As orthorexia progresses, a day filled with sprouts, umeboshi plums, and
amaranth biscuits comes to feel as holy as one spent serving the poor and
homeless.  When an orthorexic slips (which may involve anything from
devouring a single raisin to consuming a gallon of Haagen Daazs ice cream
and a large pizza), he experiences a fall from grace and must perform
numerous acts of penitence. These usually involve ever stricter diets and
fasts.
This "kitchen spirituality" eventually reaches a point where the sufferer
spends most of his time planning, purchasing, and eating meals.  The
orthorexic's inner life becomes dominated by efforts to resist temptation,
self-condemnation for lapses, self-praise for success at complying with the
chosen regime, and feelings of superiority over others less pure in their
dietary habits.
This transference of all of life's value into the act of eating makes
orthorexia a true disorder.  In this essential characteristic, orthorexia
bears many similarities to the two well-known eating disorders anorexia and
bulimia.  Where the bulimic and anorexic focus on the quantity of food, the
orthorexic fixates on its quality.  All three give food an excessive place
in the scheme of life.
As often happens, my sensitivity to the problem of orthorexia comes through
personal experience.  I myself passed through a phase of extreme dietary
purity.
When I wasn't cooking at the commune, I managed the organic farm.  This
gave me constant access to fresh, high-quality produce.  I became such a
snob that I disdained any vegetable that had been plucked from the ground
for more than 15 minutes.  I was a total vegetarian, chewed each mouthful
of food 50 times, always ate in a quiet place    (which meant alone), and
left my stomach partially empty at the end of each meal.
After a year or so of this self-imposed regime, I felt clear-headed,
strong, and self-righteous.  I regarded the wretched, debauched souls about
me downing their chocolate chip cookies and french fries as mere animals
reduced to satisfying gustatory lusts.  But I wasn't complacent in my
virtue.  Feeling an obligation to enlighten my weaker brethren, I
continually lectured friends and family on the evils of refined, processed
food and the dangers of pesticides and artificial fertilizers.
I pursued wellness through healthy eating for years, but gradually I began
to sense that something was going wrong.  The poetry of my life was
disappearing.  My ability to carry on normal conversations was hindered by
intrusive thoughts of food.  The need to obtain meals free of meat, fat,
and artificial chemicals had put nearly all social forms of eating beyond
my reach.  I was lonely and obsessed.
Even when I became aware that my scrabbling in the dirt after raw
vegetables and wild plants had become an obsession, I found it terribly
difficult to free myself.  I had been seduced by righteous eating.
The problem of my life's meaning had been transferred inexorably to food,
and I could not reclaim it.

Tacos, Pizza, and a Milkshake.

I was eventually saved from the doom of eternal health food addiction
through two fortuitous events.  The first occurred when my guru in eating -
a vegan headed toward fruitarianism - suddenly abandoned his quest.  "A
revelation came to me last night in a dream," he said.  "Rather than eat my
sprouts alone, it would be better for me to share a pizza with some friends."
His plaintive statement stirred me, but I could do nothing to change my way
of life until a Benedictine monk named Brother David Steindl-Rast kindly
applied some unorthodox techniques.
I had met Brother David at a seminar he gave on the subject of gratitude.
I offered to drive him home, and on the way back to the monastery, I
bragged a bit about my oral self-discipline. Brother David's approach over
the subsequent days was a marvelous case of teaching by example.
The drive was long.  In the late afternoon, we stopped for lunch at an
unpromising Chanteuse restaurant in a small town.  To our surprise, the
food was authentic, the sauces were fragrant and tasty, the vegetables
fresh, and the eggrolls crisp and free from MSG.  We were both delighted.
After I had eaten the small portion which sufficed to fill my stomach
halfway, Brother David casually mentioned his belief that it was an offense
against God to leave food uneaten on the table.  Brother David was a slim
man, so I found it hardly credible that he followed this precept generally.
 But he continued to eat so much that I felt good manners, if not actual
spiritual guidance, required me to imitate his example.  I filled my belly
for the first time in a year.
Then he upped the ante.  "I always think that ice cream goes well with
Chinese food, don't you?" he asked.  Ignoring my incoherent reply, Brother
David directed us to an ice cream parlor and purchased me a tripple-scoop
cone.  As we ate our icecream, Brother David led me on a two-mile walk.  To
keep my mind from dwelling on my offense against the health food gods, he
edified me with an unending stream of spiritual stories.  Later that
evening, he ate an immense dinner at the monastery dining room, all the
while urging me to take more of one dish or another.
I understood his point. But what mattered more to me was the fact that a
spiritual authority, a man for whom I had the greatest respect, was giving
me permission to break by health food vows.  It proved a liberating stoke.
Yet more than a month passed before I finally decided to make a definitive
break.  I was filled with feverish anticipation.  Hordes of long-suppressed
gluttonous desires, their legitimacy restored, clamored to receive their
due.  On the drive to town, I planned and replanned my junk food menu.
Within 10 minutes of arriving, I had eaten three tacos, a medium pizza, and
a large milkshake.  Too stuffed to violate my former vows further, I bought
the ice cream sandwich and a banana split home.  My stomach felt stretched
to my knees.
The next morning I felt guilty and defiled.  Only the memory of Brother
David kept me from embarking on a five-day fast. (fasted only two days.)
It took me at least two more years to attain a middle way and eat easily,
without rigid calculation or wild swings.
Anyone who has ever suffered from anorexia or bulimia will recognize
classic patterns in this story: the cyclic extremes, the obsession, the
separation from others.  These are all symptoms of an eating disorder.
Having experienced them so vividly in myself 20 years ago, I cannot
overlook their presence in others.

A Menu or a Life?

Consider Andrea, a patient of mine who suffered from chronic asthma. When
she came to see me, she depended on several medications to stay alive.  But
with my help, she managed to free herself from all drugs.
First, we identified foods to which Andrea was sensitive and removed them
from her diet. Milk was the first to go, then wheat, soy, and corn.  After
eliminating these four foods, the asthma symptoms decreased so much that
Andrea was able to cut out one medication.  But she wasn't satisfied.
Diligent effort identified other allergens: eggs, avocado, tomatoes,
barley, rye, chicken, beef, turkey, and tuna.  These too Andrea eliminated
and was soon able to drop another drug entirely.  Next went broccoli,
lettuce, apples, and trout - and the rest of her medications.
Unfortunately, after about three months of feeling well she began to
discover sensitivities to other foods.  Organges, peaches, celery, and rice
didn't suit her, nor did potatoes, turkey, or amaranth biscuits.  The only
foods she could definitely tolerate were lamb and (strangely) white sugar.
Since she couldn't live on those foods alone, Andrea adopted a complex
rotation diet, alternating grains on a meal-by-meal basis, with occasional
complete abstention to allow her to "clear."  She did the same for
vegetables with somewhat more ease, since she had a greater variety to
choose from.
Recently, Andrea came in for a visit and described the present state of her
life.  Wherever she goes, she carries a supply of her own food.  She
doesn't go many places.  Most of the time she stays at home and thinks
carefully about what to eat next, because if she slips up, the consequences
continue for weeks.  The asthma doesn't come back, but she develops
headaches, nausea, and strange moods.  She must continuously exert her will
against cravings for foods as seemingly innocent as tomatoes and bread.
She was pleased with her improvements and referred many patients to me.
But I began to feel ill whenever I saw her name on my schedule.  The first
rule of medicine is "above all, do no harm."  Had I really helped Andrea,
or had I harmed her?  If she had been cured of cancer or multiple
sclerosis, the development of an obsession might not be too high a price to
pay.  But when we started treatment, all she had was asthma.  If she took
her four medications, she also had a life.  Now all she has is a menu.  She
might have been better off if she had never heard of dietary medicine.
I am generally lifted out of such melancholy reflections by success
stories.  I have another client whose rheumatoid arthritis was thrown into
total remission by one simple intervention: adding foods high in trace
minerals to his diet.  Before he met me, he took prednisone, gold shots,
and anti-flammatories.  Now he has gone a full year without a problem.
Seeing him encourages me not to give up entirely on making dietary
recommendations.
But my enthusiasm will remain tempered.  Like all medical interventions -
like all solutions to difficult problems - dietary medicine dwells in a
grey zone of unclarity ad imperfection.  It's neither a simple, ideal
treatment, as some of its proponents believe, not the complete waste of
time conventional medicine has too long presumed it to be.  Diet is an
ambiguous and powerful tool, too complex and emotionally charged to be
prescribed lightly, yet too powerful to be ignored.

Stephen Bratman, M.D., is a holistic physician practicing in Ft. Collins,
Colorado.  He is the author of The Alternative Medicine Sourcebook: A
Realistic Evaluation of Alternative Healing Methods. (Lowell House)