Question of the Day

One of the most common families of questions that come in related to our blog, the Older Bolder Life, is about our recipes posted on the site. Usually questions have to do with changing up the recipe in some way, though recently several have asked why I post so many recipes on the site.

Like most things we all deal with in life, there are short, simple answers, and another explanation that’s a bit more longwinded and expansive.

Short Answer No. 1: We Really Enjoy Eating Good Food

Though neither my wife nor I were raised in what you’d call “foodie households”, over the years we’ve truly come to love preparing, and enjoying, great food. As I’ve shared many times before, we’re children of the South (Texas), and both grew up watching at least one family grandmother lovingly prepare downhome, simple and nourishing, stick to the ribs country-style food. We’ve been drawn over the years to the spice and flavor paradigms of the American Southwest as well, particularly the tri-cultural amalgam that epitomizes native New Mexico cuisines.

Bottom line, we like to eat. And cook. (I’ve often thought over the past decade that if I’d not gone into medicine, I would have become a chef.)

Short Answer No. 2: The Science of Food is Fascinating

As a science nerd, the science of food is fascinating.

Not only is the study and science of macro- and micronutrients and their impacts on human metabolism and physiology ever evolving and expanding, but the myriad chemical (and structural) changes in foods as they’re grown, harvested, stored, prepped, and cooked (how about the Maillard Reaction for instance?) will always beckon, and invite endless avenues for fruitful, and fun, exploration.

The Longer Answer: Answering the “So What the Hell are We Going to Eat” Question

The longer answer comes from our own experience over the past several years. Back in 2016, I was the first in our clan to jump on the low carb, moderate protein, higher healthy fat bandwagon. As we were transitioning off the standard American diet at the time, we jumped in and made the typical major changes in how we approached food. Not unexpectedly, the pounds began to fly off, and my lovely wife took notice.

One afternoon we sat and talked through the concepts; she was intrigued but grew more and more quiet the more detail I shared about the carb-paradigm shift required. Finally, she interrupted and asked the question we all ponder at one time or another –

So what in the hell are we actually going to eat???

We talked through a rational transition plan, and I pledged to up our home food game to smooth the transition. As I’ve shared before, we’ve never looked back, and are eating better food, to absolute satiety, with a much more innovative, interesting, and fun menu plan that ever before.

As have many before us, we’ve noticed the ability to savor and really taste the nuances of flavors in foods and spices has multiplied several times over during the past several years, enhanced in part by dumping toxic food components (here’s looking at you seed oils and highly processed foods) from our kitchen and diet. Food really does taste better.

So why do we post so many recipes. In part, it’s due to our own continued exploration of a new food and nutrition paradigm, but mainly we just love to eat good food.

Today’s question comes via reader Kathy P. in Austin –

I’ve just had a very unsettling interaction with my new internist, a woman physician I’m guessing in her early 40s (new doctor assigned because of insurance change). She was asking me about my diet, and I told her I’ve been eating paleo now for nearly 4 years, dropping 72 pounds the first year, with my weight stable at 138-139 now for three years. My husband and I love to cook, and share meals with friends several days per week.

I intermittent fast 3-4 days per week and try to spend a month in keto sometime in the first quarter of every year. My standard bloodwork has never looked better.

As a matter of background, I’m a college professor, marathoner and wannabe triathlete, am 51, 5’10” tall, weighed 138 in the office, with a calculated BMI of 19.9.

Despite my weight and fitness status, my new doc launched into an angry tirade about “paleo poison”, asked if I ate whole grains and legumes, and pronounced me as suffering from orthorexia nervosa. She basically stormed out after that interaction and sent her PA in to set me up for counseling, which I refused.

Wow, and a Quick Suggestion

Kathy, that’s quite a story, though sadly the second time I’ve heard something very similar in the past two weeks. Your high level function professionally and recreationally, lean body mass, and reported evidence of good general health (blood work mentioned above) all support that you’re doing a lot of things right. Perhaps you caught your new doc on a bad day; more likely, you need to petition the insurance gatekeepers to help you select another doc, and I’d encourage you to be very frank if they ask why.

So What is Orthorexia Nervosa?

The term orthorexia nervosa was coined by Drs. Steven Bratman in either 1996 or 1997; here’s his own introduction to the term written on an eating disorder website –

It is good to eat healthy food. We are encouraged to do so by major medical associations, personal physicians, celebrities, schools, employers, the media and even the US government. However, there are a variety of recommendations available regarding what eating healthy means, and some of these are stricter than others. Some people in their quest to be as healthy as possible begin to choose increasingly restricted diets and develop an obsessive, perfectionistic relationship with eating the right foods. This may go so far as to become psychologically and even physically unhealthy. In other words, it can become an eating disorder.

This unhealthy relationship with healthy foods is referred to as orthorexia nervosa from the Greek orthos, meaning “correct or right” and orexia, meaning “appetite.” While orthorexia nervosa is not listed in the DSM-V (the Diagnostic and Statistical Manual used by mental health practitioners to diagnose mental health problems), it is the subject of growing academic research and has become an accepted diagnosis in the mental health community.

A person with orthorexia nervosa has become so fixated on eating healthy food that this one goal begins to squeeze out and diminish other important dimensions of life. Thinking about what to eat replaces relationships, friendships, career goals, hobbies and most other pleasures of being alive. In extreme cases, the obsession with restricting one’s diet can lead to dangerous malnutrition, a truly ironic consequence of what began as a search for improved health.

The remainder of the article is worth a read, particularly as Dr. Bateman describes the progression of orthorexia nervosa in stages, the first of which is “adopting a theory of healthy eating”.

So What Differentiates Orthorexia Nervosa from Healthy Eating?

Here are several common examples of unhealthy behaviors that typify ON –

Fixation over the quality or purity of food.

Inflexible, rigid eating patterns.

Severe emotional turmoil if “the rules” are broken.

Elimination of entire food groups. (Likely the trap that Kathy fell into in the mind of her internist).

Compulsive checking of ingredient lists and nutritional labels.

Increasing concern about the health of food ingredients.

Unusual interest in the health of what others are eating.

Spending hours per day thinking about food to be eaten in the near future.

Obsessive following of food/healthy lifestyle sites on social media.

High distress if “safe or healthy” foods aren’t available.

Compulsive macronutrient tracking.

A focus on weight loss or body image concerns may or may be present.

Detailed behavioral criteria for the diagnosis of orthorexia have been proposed; here’s an example from 2015.

Back to Kathy’s Question….

Three quick thoughts. One, Kathy, given the thumbnail sketch you’ve provided of yourself and your history, and looking through the typical features of orthorexia nervosa (see other approaches to describing typical symptoms here and here), I’d put money on you being a successful paleo foodie and fitness junkie and not suffering from orthorexia. (My purpose here is purely educational, so that’s not a set-in-stone-diagnosis…)

Two, you may have been caught in what some are beginning to describe as an escalation of hostility from some in establishment medicine toward those choosing what appear to be better alternative nutritional paths. It’s time for another new gatekeeper primary care doc, and may your search be fruitful.

Three, in no way is it my intent to belittle orthorexia nervosa here today. There are people suffering mightily from the condition; I saw them as a physician in practice and see them now, more frequently than you might initially think, now as a health coach. From where I sit, a striking percentage are vegans, though I see them in all walks of life, and following any and all sorts of nutritional program approaches you can imagine. Orthorexia can inflict devastating consequences, and if you know someone teetering on the edge of orthorexic behaviors, reach out a caring, helping hand and help them engage with someone who can help.