You Can’t Make This Stuff Up

Following on the heels of my previous entry regarding the absolute lack of credentials that MDs have in the field of nutrition, I discovered today that there is actually a movement afoot in the medical community to define an interest in healthy eating as a disease. I kid you not.

Their new "disease" is called orthorexia. Of course, they are defining an interest in healthy eating as an "obsession," but eating a raw foods diet, an Ornish diet, a vegetarian diet, a paleolithic diet, or essentially anything but an SAD (Standard American Diet), is considered prima facie evidence of an "obsession" with healthy eating.

Of course, if any of these doctors actually followed the nutritional research, they would know that the SAD diet is incredibly unhealthy. It is undeniably the root cause of both obesity and adult-onset diabetes, as well as the primary cause of heart disease.

In comparison, the diets which are claimed to be symptoms of orthorexia are actually quite useful for clearing up a variety of health problems, many of which were caused by the combination of a SAD diet and prescription drugs in the first place.

Of course, that brings us to the recommended cure for this "disease." It is drugs, of course! Specifically, antidepressants, because, by all means, a focus on improving one's health through diet is a sign of depression, right? Actually, quite the opposite. But that's a topic for another day.

What is also interesting is the background of some of the medical "authorities" promoting this imaginary illness.

Let me first point you in the direction of Steven Bratman, MD. No, I'm not going to post his URL here, because just reading that site makes me a little ill, but you can find it easily enough with the help of Mr. Google.

Bratman is a self-proclaimed "quackbuster," which means he ignores all research which disagrees with his preconceived opinions. He has also written a book, "Health Food Junkies," which -- surprise -- is all about this mythical disease of orthorexia.

Of course, Bratman has the qualifications to address nutritional disorders and therapeutics because, according to his biography,  he opened a now-defunct health clinic, where he "worked closely with a wide variety of alternative practitioners, and received training in acupuncture, herbal medicine, nutrition, massage, osteopathic manipulation, and body-oriented psychotherapy."

Ok. So this guy's qualifications are...he watched someone else do nutritional counseling? Holy cow, asking Bratman for nutritional advice would be like asking someone to pilot an airplane because they've watched a few take off.

He's also written a lot of books, mostly for the pharmaceutical industry, and serves as a "consultant" in alternative medicine, whatever that may be. Pretty good for a guy who, according to his own data, possesses no certifications, license, or formal education in the field of alternative medicine.

In fact, I would be willing to bet I have had more formal education in pharmacology -- drugs, that is -- than Bratman has had in clinical nutrition.

Unfortunately, people do listen to unqualified individuals such as Bratman, and thus incredibly inane ideas such as orthorexia get wheels.

All of this wrongheaded manipulation over proper eating reminds me of a case I had a number of years ago. A mother came to me concerned because she thought her teenage daughters should be on a diet. Of course, I agreed to evaluate the girls and see if there would be some way in which I could help.

A few days later,  the patients came in. I conducted a history and physical exam, and low and behold, the girls were healthy. While perhaps a bit on the high side of normal in terms of their body fat, they were still within the normal range. They were physically active, with no complaints. Their diet, while not the best in the world, actually included some fruits and vegetables, which I considered an astounding success for two late-20th-century adolescents.

In short, there was really nothing much to do.

I consulted with the parent, and said that the girls looked fine, and I thought any special diet was unnecessary.

Mom began arguing with me. "Isn't there some diet you could give them?" she asked.

I told her to bring the girls back in a few days, during which time I would do a more thorough analysis of their food journals and see if there were some pertinent recommendations that I could make.

When they came back,  they entered the office with an air of excitement and anticipation. And it slowly began to dawn on me what was happening.

I was the instrument of a rite of passage: A Girl's First Diet. Like menarche or a training bra, the Diet was a step on the pathway to womanhood, because, of course, dieting is something all women must do.

I brought the girls and their mother in, and sat them all down. I explained to them that I had reviewed their diets carefully, as well as their physical exam findings, and that the best thing that they could do for their diet would be to include more fish and have more vegetables, particularly cruciferous vegetables. They should also make sure they should drink plenty of water.

Their faces fell with disappointment.

"Don't you have a meal plan for us?" One asked.

"I don't really like fish," said the other.

"What about foods they shouldn't have?" said the mother.

I explained to the disappointed multitude that, in fact, their diets were already pretty good, except for the absence of omega 3 fatty acids, which would be satisfied by the inclusion of fish. I added that I saw no reason to restrict their foods or create an unnecessary diet plan to follow, given their overall good health.

Their disbelief was palpable. I had ignored all of the sacraments of this ritual, developed at the Church of Weight Watchers and practiced at the altar of Jenny Craig. There was no arcane list of proscribed foods. No complex eating plan. No admonishments against those foods which medical doctors consider bad for you, like butter, or whole milk, or red meat.

We went back and forth for a while; it really took a good 15 minutes to get through to them that I really didn't want them to restrict their eating, but rather they should just emphasize certain foods. After they eventually realized I was not about to capitulate to their desire for their First Real Diet, two confused girls and a rather angry mother left.

I don't know whether or not the girls eventually got their diet or not, but the encounter did get me thinking about how twisted the messages about healthy eating and good nutrition get in this society. Somehow, medicine and marketing have turned a wholesome diet full of a range of nutrients, with an emphasis on foods that do not contain pesticides, hormones, chemical additives and preservatives, into an illness.

Orthorexia? If it were really a disease instead of a chimera, I would wish that more of my patients suffered from it.