STEVE INSKEEP, HOST:
You know the common advice when it comes to your diet. Try for moderation, people say. You don't want too much of anything. It turns out that advice applies even to the way you think about your diet. An extreme focus on eating only the right foods can risk your mental and physical health. April Fulton explains.
APRIL FULTON, BYLINE: Alex Everakes is a 25-year-old public relations executive from Chicago. He knows about clean eating. For a time, he was obsessed with the purity of everything he put in his mouth.
ALEX EVERAKES: Spinach, chicken, egg whites.
FULTON: At one point, he only ate 10 foods.
EVERAKES: Asparagus, salmon, unsweetened almond milk.
FULTON: He didn't always eat this way. As a kid, Everakes struggled with being overweight. In his teens and 20s, he tried to diet and gained and lost and regained about a hundred pounds. When he moved to Los Angeles, he took his diet to a new level.
EVERAKES: I even picked my vegetables so that I wouldn't be bloated. That's literally how obsessed I got.
FULTON: He lost a lot of weight, posted pictures online and got tons of positive reinforcement. People loved his six-pack abs. But in reality, he was starving, tired and lonely. Alex was afraid of some foods. He worked at home to avoid office parties. He didn't make friends because he didn't want to eat with people or explain his diet.
EVERAKES: My life, literally, was modeled to put myself away from distraction of my fitness.
FULTON: Alex was struggling with something called orthorexia nervosa. Dr. Steven Bratman first coined the term in 1997. Some of his patients would ask, what foods should I cut out of my diet to be healthy?
STEVEN BRATMAN: People would think they should cut out all dairy, they should cut out all lentils, all wheat. And it dawned on me gradually that, many of these patients, their primary problem was that they were far too strict with themselves.
FULTON: So Bratman made up a name, orthorexia, borrowing ortho from the Greek word meaning right, and orexia, meaning appetite.
BRATMAN: From then on, whenever a patient would ask me what food to cut out, I would say, we need to work on your orthorexia. This would often make them laugh and let them loosen up, and sometimes it helped people move from extremism to moderation.
FULTON: Bratman had no idea the concept of clean eating would explode. Where dieters once gobbled down sugar-free gelatin, now they might seek out organic kale and wild salmon. The rise of celebrity diet gurus and glamorous food photos on social media reinforce the idea that eating only certain foods and avoiding others is a virtue. Sondra Kronberg has seen a lot of diet trends over the last 40 years. She's the founder of the Eating Disorder Treatment Collaborative in New York.
SONDRA KRONBERG: Orthorexia is a reflection on the cultural perspective on eating cleanly, avoiding toxins, including foods that might have some superpower.
FULTON: Now, Kronberg applauds eating healthfully. The problem comes, she says, when people are so focused on their diet that they miss out on life. That's when you should start to worry about an eating disorder.
KRONBERG: In the case of orthorexia, it centers around eating cleanly and purely, where the other eating disorders center around size and weight and a drive for thinness.
FULTON: Sometimes these problems overlap, she says, and some people who eat only clean foods don't eat enough and can actually miss out on critical nutrients. While people are showing up in clinics with these problems, scientists don't agree on exactly what orthorexia is. There are only about 150 studies on it, while the well-known eating disorders have tens of thousands. But it is treatable. Dr. Steven Bratman.
BRATMAN: Most eating disorders are treated in pretty much the same way. You have to work with people's behaviors. You have to counsel them on their health and their nutrition. And you have to look for underlying anxiety, obsessive-compulsive issues, control issues.
FULTON: Alex Everakes has been in treatment for two years. While he's still significantly underweight, he says he's happier and learning to see his diet a little differently. For Alex, taking control of his orthorexia is...
EVERAKES: Knowing that your world isn't going to come crashing down if you have, like, a piece of pizza.
FULTON: He's managed this by taking baby steps.
EVERAKES: What I did is I had a piece of cauliflower pizza first.
FULTON: He eats more freely on the weekends now and tries to add a new food every few days. If you think you or someone you know has orthorexia or any eating disorder, get professional help and talk to your friends, Alex says, because it's very hard to change these patterns on your own. For NPR News, I'm April Fulton.