When restrictive eating becomes disordered eating

I am a believer in healthy eating.  Vegetarian, made-from-scratch, whole grain.  I read labels.  I like things that are "natural."  I munch veggies.  But at the same time, I'm more than happy to engage in the occasional totally non-healthy, non-wholesome meal because, even though it might not have the Recommended Daily Allowance of vitamins and minerals, it feeds some other part of me.  I'm also very skeptical of those that preach or adhere to healthy eating plans that really just translate into dissatisfaction with our natural body shapes.  Just as I'm wary of the potential for exercising for health reasons getting all blurred together with unrealistic appearance expectations and consequently self-hatred, I think there's all too fine a line between what we do for our health and what we do for the girl in the mirror when it comes to eating.

Moreover, even if someone is able to separate out the skinny-craving self (thanks to our society, this being lives in all of us) and really just pursue a restrictive diet for health reasons, I still believe this diet can become unbalanced in a way that is ultimately unhealthful.  What I mean by this, is that if someone is so firm in their adherence to a vegan, raw-food diet, for example, that they can't even have a taste of chocolate cake on their birthday, the negative mental effects (which in turn can affect physical health) might be more detrimental than the trans fats contained in that tiny cake sliver.  Now, this isn't to say we can't have rules.  I, for example, don't eat meat, and this is a hard-and-fast enough rule that I wouldn't try someone else's lamb tikka, no matter how much I wanted it.  But my question is, when do these rules start to harm more than they help?

Gena from Choosing Raw tackles this issue in a recent guest post at Whole Living.  She first discusses the eating disorder orthorexia nervosa, an obsession with healthy food, identified by Steven Bratman, a holistic physician who had suffered himself from a too-rigid diet (from Dr. Bratman's original piece):

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 up (which may involve anything from devouring a single raisin to consuming a gallon of Haagen Dazs 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.

But for those of us who prefer, for health reasons, or need to, for medical reasons, to eat a restricted diet, how do we draw the line between normal restrictive eating and disordered eating?  Gena sets forth a mindset guideline that seems in line with Dr. Bratman's demarcation of illness:

How do we distinguish these modest efforts from the extremes that orthorexia nervosa describes? Because orthorexia is a psychological fixation, rather than an overt attempt to lose weight (as in other eating disorders), it can be hard to characterize. Where does a passion for healthy food and fitness end, and psychological disturbance begin?

The answer exists, but I think it’s as hazy as the question itself. The key to eating healthily while avoiding rigidity lies in a reasonable mindset. It’s great to take steps toward eating cleanly. But it must be done with the right intentions: the goal should be a well-rounded life, and not a rigid, socially isolated one; a vibrant body, rather than one that’s been put through rigors of starvation.

But even stopping far, far short of the disordered mindset of stringent, ever-shrinking guidelines, self-punishment, and deprivation, I believe it is possible for restrictive eating to become, if not disordered, then...imbalanced.  I've actually experienced this recently, after a bout with malaria left me with a much more sensitive digestive tract.  Since everything I ate seemed to irritate my stomach, I started cutting out foods to try to root out the culprit.  After a day of a bad stomach-ache, I would spend the next day eating only "safe" foods like bread and rice.  Slowly, I found my proudly normal eating habits erode and become replaced by hunger, paranoia, and guilt.  The need to eat restrictively threw my eating habits deeply out of balance.  For someone else, the desire to eat restrictively might do the same thing.

So how do we really tell if our dietary restrictions allow us to maintain a healthy approach to eating (by which I mean mentally, not nutrition-wise)?  I think you'll know when you've found a healthy approach when you feel comfortable in your eating habits, like worn-in shoes, and not like you're always on edge.  This is something that's harder to find than it sounds, though, especially when placing more onerous restrictions on your diet.

For a good self-check, see if Ellyn Satter's definition of normal eating, which remains a good guide years after she originally wrote it, sounds consistent with your habits, or like a far-off ideal.

Normal eating is going to the table hungry and eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it—not just stop eating because you think you should. Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food. Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good. 

Normal eating is mostly three meals a day, or four or five, or it can be choosing to munch along the way. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.

In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings.

Copyright © 2009 by Ellyn Satter. Published at www.EllynSatter.com. For more about eating competence (and for research backing up this advice), see Ellyn Satter’s Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook, Kelcy Press, 2008. Also see www.EllynSatter.com/shopping to purchase books and to review other resources.

I think many of us may read this and think "Maybe if I was skinny, I could eat like that."  The myth that normal eating is a luxury for the slender is part of the broader, insidious fantasy of being thin.  For those of us struggling with medical issues, this might also seem like an unrealistic ideal for the time being.  But I think I'll know when I've solved my dietary issues when I can go back to eating like the above.  I recognize that this form of eating may not be feasible for everyone--individuals with diabetes, for example, may only be able to build flexibility into their diets at some times--but to me it's a healthier, more feminist base to start from than the current "eating towards a goal" paradigm that's constantly being sold to us.