Your Low-Carb Lifestyle Comes with a Mental Health Risk

For about nine years, Saha lifted weights almost daily, and toyed with raw vegan and low carb diets. Over time, he noticed his energy wane, he was unable to perform his usual workouts, and when he hit the gym, his eyes were bloodshot.

One day, he came across Dr. Steven Bratman’s website. It was populated with narratives surrounding people’s stringent food habits—cutting out this, never going near that—and how it disrupted their daily lives, from canceling dinner plans with friends out of fear of unhealthy menu items to malnutrition. Saha identified with these stories and took Bratman’s self-assessment for a condition called orthorexia, a compulsive obsession with healthy eating, a term he coined in 1996. Questions on Bratman’s test include “I spend so much of my life thinking about, choosing and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work and school” and “My personal sense of peace, happiness, joy, safety and self-esteem is excessively dependent on the purity and rightness of what I eat.” 

Saha completed the short questionnaire and self-diagnosed with orthorexia, not a Diagnostic and Statistical Manual-recognized eating disorder, but an affliction that was impacting his day-to-day. “A lot of people thought I was healthy,” Saha remembers, “but internally, the way I viewed my own body wasn’t healthy at all.”

Now 27, Saha has written about nutrition in the books How You’re Meant To Eat and an upcoming text on orthorexia. He’s working hard to correct the disordered eating habits associated with orthorexia and instead preaches the benefits of listening to your body regarding the kind of fuel it needs.

Because orthorexia is not a formally classified eating disorder, it’s difficult to put a number on how many people experience the condition, though results of a study released in 2016 estimated less than one percent of researcher’s sample of 275 U.S. college students had orthorexia. A 2004 study found that out of 404 subjects, 6.9 percent of participants suffered from orthorexia, most of whom were male. Research from 2010 showed that men had a higher tendency for orthorexia than women. Further, male nutrition and dietetics students in Istanbul reported more orthorexic behaviors than their female counterparts, according to a 2017 study.

For Saha, aesthetic and athletics were his gateways into disordered eating. Brian St. Pierre, director of performance nutrition at digital coaching platform Precision Nutrition, says these fixations are prevalent within the fitness and nutrition communities, regardless of gender. Since the lifestyle is their job, he says, the line between what is healthy and what could potentially be damaging is blurred. When there’s pressure on high performance, like in bodybuilding, people tend to focus on the final product, often comparing themselves to highly edited images in magazines and on social media without realizing the process to get to such a point shouldn’t be maintained over an extended period of time. “The images that are sold of really fit men and what people often don't realize is how doctored those photos are, though,” St. Pierre says. “Even someone like Hugh Jackman, who’s being paid to look a certain way on screen, still goes through a really intense protocol to look better just for that one day. People think they can look like that every day. It’s a discrepancy versus what’s an everyday reality.” 

But because of our culture’s heavy focus on clean eating—and praise for doing so—what can begin as meal prep can quickly escalate into a rigid routine, says Los Angeles marriage and family therapist Christie Tcharkhoutian. Men in particular, she continues, “are often praised for their discipline in working out,” and can take that same control into their meals. “They will often be the one in the kitchen cooking so they know what is going in their food at all times.”

In her work as a dietician, Jessica Setnick has seen both men and women face the same pressures when it comes to body image, however men often have less to work with in terms of transformative tools, like makeup and hair. “Guys really only have their hair, their facial hair, and their bodies,” Setnick says. “There absolutely can be a lot of pressure.” Opposed to “traditional” dieting, men might gravitate toward food challenges like Whole 30 and keto as a way to focus on the health aspect of eating rituals.

It’s this relationship with food that Setnick says is the most important when it comes to orthorexia. If a person’s diet is lacking in grains or fats, for example, there’s usually an underlying reason for why. Were you prohibited from eating sweets as a kid because of your weight? Did a relative make comments at family gatherings whenever you ate bread? These sorts of memories tend to stick with us and impact our views on food.

St. Pierre says it boils down to a black-and-white “good” and “bad” food scale. “Get away from moralized food,” he says. “That mindset ends up leading you down the road of disordered eating.” Instead, he suggests looking at food on a spectrum and so long as most of your diet isn’t on the lower end of that range (foods with little-to-no nutritional value), you’re on the right track.

Setnick agrees: “Everybody loves those books: ‘Eat This, Not That!’ Top ten things you should eat for a long life. We love anything that makes the decision for us,” she says. “The problem is, there is so much context when it comes to food." According to Setnick, men will take the death or medical emergency of a loved one into consideration when altering their diets. If Dad has to eat a low-cholesterol diet, so should I becomes the mantra. “How much cholesterol can you cut out because you worry that your dad’s going to die?” Setnick says. “Changing our food intake doesn’t change any of that. For a short period of time, it may make you think you're taking control of the situation.” 

Regardless of health trends—from lifestyle changes like paleo and biohacking, to fitness ideals like building muscle or leaning out—if thoughts of food dominate your day, it may be time to seek treatment. (The International Federation of Eating Disorder Dietitians has a specialist locator on their website.)

“If someone is eating in a certain way because they want to change their body,” Setnick says, “if it’s impairing their functioning—that’s orthorexia.”