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Sharon Price, MS, CNS, LN, offers personalized nutrition counseling to help individuals and families navigate the often-complex interplay between food and health— taking a special interest in healthy body composition, gut health, and food allergies. Her goal? To help individuals and families savor good health without feeling enslaved to its pursuit.


By Sharon Price, MS, CNS, LN

Sharon Price, MS, CNS, LN

Orthorexia nervosa is defined as “an obsession with eating foods that one considers healthy,” or “a medical condition in which the sufferer systematically avoids specific foods in the belief that they are harmful.”

This lesser-known type of disordered eating can be insidious. It often masquerades as healthy eating, and can be particularly prevalent in the fitness and nutrition industries. But as a nutritionist—with a healthy love of food—how do I deal with this issue in my practice?

One of the trickiest parts can be figuring out when it’s orthorexia— or whether that’s the primary issue—and when the issue is more physiologically-based.

I frequently see people with very complex gastrointestinal (GI) issues. Someone who swells up or has pain after eating and can’t figure out why will naturally experience trepidation about food. But which came first, the GI issues or the anxiety?

I typically see three types of situations where I consider orthorexia. In all three, the person may present with a very limited diet, with nutritional deficiencies and fatigue, and with family and even other professionals who have expressed concern about their food intake. Eating and food have taken over a lot of their lives, or certainly the quality of life.

Restricted Eating

One example is “Simone,” who had experienced years of GI distress, including bloating and pain after eating, alternating constipation and diarrhea, and other distressing symptoms. And she had been unable to find a pattern that completely explained or resolved any of them.

It wasn’t for lack of trying. Intelligent and resourceful, Simone had tried a variety of different eating approaches in the pursuit of relief: low FODMAPs, autoimmune protocol, low histamine, low oxalate, gluten and dairy free, and more.

Despite blips of temporary relief, nothing ever really got her back to “normal.” By the time I saw Simone, even her friends had begun expressing frustration with her and the situation. She had learned to mask her very-high level of distress while increasingly restricting her eating so as not to interfere with social plans.

When I began working with her, Simone’s diet included a very small number of foods eaten primarily for sustenance. The pleasure from eating had long-since disappeared, yet she still had a positive and determined attitude to get to the bottom of her issues.

Intense Discomfort When Eating

Another example of this disorder is “Jessica”—who described a lot of the same symptoms as Simone, although initially hers had begun after a bad bout with food poisoning. But her discomfort continued long past that initial incident, and she hadn’t been able to find any explanation for her inability to consume moderate servings of food or even liquid without intense discomfort.

While what looks like disordered eating can actually be driven by long-standing GI issues, that very situation can also lead to an unhealthy posture towards food.

Unlike Simone, Jessica showed clear muscle wasting and tensed up any time we discussed food or even energy levels. In this case, along with the initial physiological trigger, I now recognized clear signs of disordered eating.

Eating as an Ordeal

Disordered eating was certainly the primary issue in the case of a third client—an adolescent who refused to eat in front of anyone else and would only eat a very narrow list of foods at all. She presented with nutritional deficiencies and a host of other issues associated with poor or under-nutrition.

In that case, I referred the family to a mental health specialist and to a nutritionist who specialized in eating disorders.

Finding a Healing Path

I’m focused on uncovering and addressing root causes where possible. Some clients have already completed extensive food sensitivity and other testing. Once I understand the results, I develop a structured plan to help heal the gut and gradually begin to reintroduce a greater variety of foods.

In other cases, we may not know the root cause. I luckily work in an integrative practice where we can get a much more in-depth understanding of health issues. But each person is different and may present with unique requirements even with how to implement a low-histamine diet, for example.

My approach starts with understanding individual needs, expanding the options, and trying to make eating less of a chore as we deal with underlying issues or imbalances. Always, I focus on increasing variety and pleasure with the foods people can eat, instead of focusing on all the things they can’t.

I take even more care with individuals who have developed disordered eating patterns as a result of the very real pain and discomfort they’ve experienced with food.

We discuss adding more whole foods, increasing fiber, lowering sugars and “hidden” sugars, as well as focusing on other healthy habits and the importance of relationships and social connection. But I stop short of giving targets for calories or macros, which can become yet another source for fixation or restriction.

Because ultimately, food shouldn’t take over your life — it should support your ability to live a healthy and enjoyable one.