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    What’s With The Healthy Eating Stigma?

    Two hot topics in the media to dissect today.

    First up: Bill Clinton’s transition to a vegan diet, which continues to make the media rounds. This USA Today article took me aback with its cautionary and semi-discouraging tone.

    Especially off-putting were the words of Gina Lundberg (interesting note: when the article was originally published on Wednesday, she was credited as a spokeswoman for the American Heart Association; in the most recent version, she is referred to as a ‘preventive cardiologist’):

    “[A vegan diet] is so limited in variety and taste that people get sick of it, and they don’t stick to it.”

    Casting a vegan diet as “limited in variety” is grossly inaccurate. Removing animal products from the diet leaves thousands of foods: nuts, seeds, legumes, fruits, vegetables, grains, not to mention spices and herbs.

    I am disappointed that a preventive cardiologist did not acknowledge the heart-healthy contributions of the fiber, phytonutrients, antioxidants, and healthful fats in plant foods. I am not arguing that the sole way to health lies in veganism (after all, Coke, french fries, and Pop-Tarts are all vegan).  However, there is no doubt that increasing the amount of plant-based foods in the diet is something everyone can benefit from.

    I also wish the the last third of the article included a list of five reasons to eat more plant-based foods, rather than a list of five ‘common mistakes’ vegans make and fears of nutritional deficiencies (consider that the average American is omnivorous and does not consume sufficient amounts of calcium and magnesium, among other nutrients; yet have you ever heard the media state “omnivores are at risk for deficiencies”?).

    Topic #2: It must have been a slow news day on the Today Show yesterday, since the show’s diet and nutrition editor decided to trot out the good ol’ orthorexia story. The term, coined by Dr. Steven Bratman, has been used as sensationalist news filler for several years now. It is not a real diagnosis, but rather a ‘pop-therapy’ term to describe someone who is preoccupied with the food they eat.

    Let’s examine the claims made in the Today Show piece:

    • Orthorexia focuses on the quality of food:  Which begs the question, “So what?”. Examples of ‘symptoms of orthorexia’ include shunning food dyes, trans fats, pesticides, or groups of food. What’s the problem? I know some individuals who shun white flour. Is shunning white flour a prerequisite of eating healthfully? No. Is there anything wrong with shunning white flour, provided the person doing said shunning enjoys a myriad of other foods? Absolutely not.
    • The “key thing that is missing is moderation”: Ah, my favorite meaningless, toothless, abstract term. So as to not repeat myself, please see point #2 of this post to read my thoughts on “moderation”.
    • Is about being virtuous and being “a better person” if one restricts: I’m curious as to where this fact came from. I dislike that it gives the impression that avoiding harmful ingredients or unhealthy foods is based on elitism or moralism, rather than what it is truly based on for most people — health!
    • Spending 3 or 4 hours a day reading labels is a sign, so is “cutting out lots of things” and worrying about pesticides on produce:  If orthorexics avoid processed foods, what labels are they reading? Fruits and vegetables don’t have any, and whole foods like brown rice, nuts, oats, and whole grain breads have ingredient lists that can be read in ten seconds.
    • If you suspect someone has orthorexia — “take action!  It can lead to protein deficiencies.” Americans’ fear of protein deficiencies never ceases to amaze me.  Every single food (except cooking oils and solid fats) contains protein. Unless someone subsists on olive oil and butter, a protein deficiency is unlikely provided they consume a sufficient number of calories.

    This has more to do with psychological issues of control and compulsion, but is framed through a nutrition lens. There is a world of difference between someone who inherently fears and mistrusts food to the point where they jeopardize their health and someone who is well-informed and aware of what they put into their body.

    The average American consumes 22 teaspoons of added sugar a day, half of the recommended fiber intake, and 150 percent of the daily maximum sodium limit.  Many college students eat no more than one serving of fruits and vegetables each day.  Data from The Institute of Medicine shows that by the time they are 14 years old, 52 percent of male adolescents in the United States drink 24 or more ounces of soda each day.

    In light of that, one fact should be presented without any disclaimers: no harm can come from eating more plants and less processed food.  “Going vegan” or scouring ingredient lists for harmful ingredients should be supported, not stigmatized.



    1. Lauren said on August 26th, 2011

      Great post. You take the words right out of my mouth every time.

    2. Rebecca said on August 26th, 2011

      See what the ADA spokesperson has to say about Clinton’s vegan diet – http://www.msnbc.msn.com/id/44208743/ns/health-diet_and_nutrition/t/bill-clinton-goes-vegan-its-not-going-be-easy/#.TlgK3M0c6PV – discouraging to say the least. Why can’t this be construed in a more positive and encouraging manner? The media continues to demonize plant-based nutrient dense diets and then issues scary reports on how unhealthy Americans are. What a waste of educational potential!

    3. Andy Bellatti said on August 26th, 2011


      Very unfortunate. At least the MSNBC article acknowledges that shifting to a diet that is more plant-based offers benefits. Still, I really dislike the Debbie Downer-ism that permeates. And, as you mention, the double-talk is unbelievable (“Americans need to eat healthier foods” followed by “veganism is radical and leads to deficiencies”).

      I also have to say, however, that I am not a fan of Dean Ornish’s plan. The low-fat thing seems unnecessarily restrictive and unnecessary to me. There is no reason to shun avocados, nuts, and seeds… and getting a mere 10% of calories from fat seems like too little to me.

    4. Chef Shawn said on August 26th, 2011

      Great post, you’ve said it better than I could have. There are risks of nutrient deficiencies with any diet, if it’s done improperly. I mean, how many Americans who are omnivores are deficient in, say, Vitamin D? Or Omegas? Or Fiber? A lot, as you point out. There are also omnivores, vegetarians, vegans, and paleo/primals who have a completely balanced diet. It’s not about which diet is or isn’t healthy, it’s about what’s eaten within that framework, and it’s incredibly disheartening to continually hear the media bashing on those people who chose to make more positive and educated choices about their lifestyle. It does make me wonder who sponsored (quietly or otherwise) that Today piece, because it just sounds like more rationalization for eating poorly.

      Eating healthy isn’t a mental illness. Those who eat “healthy” because as a form of food restriction fall under another diagnosis, because it’s about restriction, not health. And, control over one’s life is no bad thing. Frankly, more Americans need to begin exerting more control over their lives, not less!

    5. Rebecca said on August 26th, 2011

      I agree about Ornish being unnecessarily restrictive, but aren’t we falling into the same trap as the media? If Clinton is following this healthy, if overly restrictive, diet and has improved biomarkers and reduced his CVD risk factors, should we be criticizing it or pointing out the lengths to which he is willing to go (and the foods he is willing to “sacrifice”) to avoid another bypass? Impressive for a man not known for curbing his appetites.

    6. Mitzi said on August 26th, 2011

      I can say we tried the very-low-fat plan for a while, but our skin got dry and itchy. We put back in more nuts, seeds, and a bit of oil (just enough to keep food from sticking), and the skin went back to normal. You don’t have to be a total vegan, but a plant-based diet is not contradicted in any of the real scientific lit I can find.
      There is a lot of stigma out there, but it is changing. One year at a small local conference, one of the speakers proudly announced that his patients’ average salt intake was 18(!) grams a day, but his drug regimen still controlled their blood pressure. I wanted to announce that I could lower my husband’s BP just as much by good diet, but as a grad student, held my peace. The next year’s keynote speaker announced it for me. Change will come, when the money runs out for expensive care, and people realize that eating well is much cheaper than the alternative.

    7. Kelly said on August 26th, 2011

      Andy, thank you for being the voice of reason! Each of your points is right on target!

    8. Andy Bellatti said on August 26th, 2011


      I am simply pointing out that, from a nutritional standpoint, I don’t understand why foods rich in heart-healthy fats are restricted in an eating plan that is all about heart health.

    9. Lauren Slayton said on August 27th, 2011

      It’s as though healthy eating is somehow threatening to people. Be careful, you may get too healthy (such a scary thought). If people let their eating get in the way of socializing or holding a job or having relationships it’s a problem. That problem doesn’t have to do with food coloring or label reading but a real problem and a lack of balance. This reminds me of the fast food conversation. It doesn’t make you rigid or sick or not fun to shun crap. In fact, I find craporexia more concerning.

    10. Andy Bellatti said on August 27th, 2011


      You hit it on the head regarding healthy eating being perceived as a threat. I particularly dislike the myth that healthy eaters walk around lecturing people. If anything, I’ve often found myself on the receiving end of comments along the lines of “you should eat a little meat once in a while for your iron levels” or “Live a little!” (as if choosing to drink water instead of soda means I am missing one of life’s greatest joys).

      I also completely agree with you regarding the socialization problem being unrelated to food choices. If anything, practically every restaurant has real, unadulterated food in some form.

      I just picture some of the Today Show’s audience thinking about how a family member who is ingredient and label-savvy may have this made-up disorder.

    11. Marianne said on August 27th, 2011

      I think it’s wrong when media puts down or diminishes any sort of healthy eating plan (be it vegan or omnivore), and I do think that the orthorexia piece might be a bit over the top. I do think that there are some people who do take the concept of healthy eating over the top and jeopardize their health (I’m thinking fat phobia, etc), but that they are few and far between. Had the piece focused more on that, it would be more credible. I see nothing wrong with avoiding unwanted additives to your foods and being conscious of reading labels carefully, but would also think that anyone who spends multiple hours a day every day reading labels probably does have some problem, unless this is actually their job. Everything can be taken to unhealthy extremes – even things that are generally healthy.

    12. WRG said on August 28th, 2011

      Let me chime in as someone who does wonder about orthorexia.

      Almost everything I eat can be shot down by someone or other: hormone-free beef or chicken (it’s flesh!), milk or cheese (it’s dairy!), whole-grain bread (full of glutens and carbs!), walnuts and almonds (too high in fat!).

      I eat fruit and veggies. At least no one can shoot me down for that…although I usually have half a banana at breakfast (so I’m not careful enough when it comes to the glycemic index).

      And horror of horrors. I feel that moderation works for me. I often eat two small squares of dark chocolate after supper. Sometimes one, never three.

      I don’t indulge in Cap’n Crunch, Twinkies, Big Macs, Doritos, Coke, etc. etc. and yet I still get the impression that I am BAD, an UNHEALTHY eater.

      Do you see why some of us do feel that orthorexia exists?

      Submitted respectfully (but meekly, due to the fear that I will be savaged by all you “healthy” eaters out there…).

    13. EA-The Spicy RD said on August 30th, 2011

      Although I am not a vegan, I completely agree that a Vegan diet can be very healthy, and I’m sure full of variety with a little creativity. I watched a little bit of a news report on this Sunday evening, and the only thing I disagreed with was the cardiologist who was speaking talked about a basically fat free vegan diet a being the way to go which I definitely disagree with!

    14. Chef Shawn said on August 30th, 2011

      WRG, people who make you feel bad for eating what you do aren’t orthorexics, they’re overbearing arses. Different disease altogether! It’s not unique to food. There will always be people who feel the need to impose their lifestyle on others in all walks of life, from religion to politics to how children should be raised.

      Seriously, though, people who preach to those who don’t want to hear it have a different set of issues, I think, than what this Today bit was suggesting. Generally, I’ve heard this “mental illness” term applied to people in regards to their own eating habits, as opposed to their evangelizing to others about food (there are lots of words for that, none of which I can post here). It would be, were it at all real, classified as a restrictive eating disorder, in the same vein as anorexia. And, I’ve definitely met people who use “healthy foods” to justify their eating disorder (I am sure it’s not limited to this, but I’ve met several vegans for whom this was the case) because it is a bit more socially acceptable. And, of course, harder to argue since someone arguing against eating healthy, environmentally-friendly, etc. comes off as selfish or uninformed. But, those people still have an eating disorder that is diagnosable under another heading that has the same root causes, they’re just manifesting in a more “socially acceptable” way. This is an incredibly small minority of people who eat healthy, and the two things aren’t intrinsically related.

    15. Christina RD said on September 11th, 2011

      Just wanted to second what Chef Shawn is saying, vegan diets are extremely common among people with anorexia in my experience, it helps to justify eating very minimally and very few types of food for some of these individuals. Nutrition is all about averages so any style of eating can be healthy regardless of some inclusion of less nutritious choices but when there is a preoccupation primarily on just minimizing calories from any food there can be a mental health disorder.

    16. Liisa said on September 12th, 2011

      I wouldn’t discount orthorexia. After all, if you take anorexia, which is, as far as I’m aware, considered an eating disorder and mental illness, you can just discount it because there’s nothing wrong in eating less, cutting on cake etc. Just because good part of people would do only better with less food and less junk food, it doesn’t mean that when done in excess, it can become a problem.
      After all, I had anorexia and I don’t consider myself entirely healthy, and one of the things I indeed did was that I was extremely picky about food in the orthorexic way. It felt very relaxing to find reasons why I can’t buy this or that for objective reasons, such as It was in the papers that green peas contain this or that which may make your ears fall off. Which, as Christina RD said, boils down to refusing food.

    17. Andy Bellatti said on September 12th, 2011


      Thank you for your comments. In light of the anecdote you share, I find it would be more helpful to speak of ‘orthorexia’ more as a common symptom/manifestation of anorexia, as opposed to a “danger of healthy eating”. Even then, the term would simply have to refer to “an extreme preoccupation with food” or “an extreme fear that food is damaging”. As it is, many of the mainstream fluff pieces on orthorexia make it sound like if someone reads five different cereal boxes at the supermarket looking for the one with the least amount of sugar (or absence of food dyes), they are in some way pathological, rather than making an informed decision. I really dislike those implications and the judgments they set up and enable.

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