Can too much healthy food hurt you?

When A., age 28, visited a Madrid eating disorder clinic, she weighed only 27 kilos, but to the doctors' surprise, she proudly described her healthy eating habits. She had become a vegetarian at age 16, on the advice of an alternative healer, due to her bad acne.

Eight years later she decided to go vegan, dropping eggs and milk products from her diet. Two years later, she started eating only organic (vegan) food, began wearing only clothes made from natural fibers, joined groups that promoted strict rules for (allegedly) healthy lifestyles, and dramatically limited the amount and frequency of her meals. After a trip to India, she reached an alarmingly low weight and had to be hospitalized immediately, her doctors stated in a scientific journal.

Reports of orthorexia, an obsessive addiction to health food, are on the increase. This disorder still does not appear in the official handbook of psychiatric diagnoses, known as the DSM, which is updated occasionally by the American Psychiatric Association. But evidence has been accumulating in medical journals, and Israeli eating disorder clinics have been reporting cases as well.

The first Israel case was documented four years ago, at the Davidson clinic in Ra'anana, part of the Shalvata Mental Health Center. The patient, a 22-year-old woman, became severely underweight after forgoing many types of food. As opposed to patients with anorexia, this woman was not concerned about her weight, but rather what she was eating, and insisted on consuming only what she considered to be health food.

The term orthorexia nervosa was first coined by Dr. Stephen Bratman, a doctor and nutritionist from Colorado, in a yoga newspaper in 1997. People with the disorder eat only "health food," and forgo foods that do not meet their strict standards, such as industrially refined and preserved foods. Studies show the disorder is slightly more prevalent in women than men, as with other eating disorders. It usually becomes more severe after age 30, and is more likely to appear in upper-class individuals with higher education. This Sunday the Guardian reported an increase of cases in Britain, citing organizations that assist people with eating disorders and the British Dietetic Association.

Diets are a well-known Israeli pastime: About a quarter of the population is on a diet, including 31% of women and 20% of men. As organic food becomes more prevalent, it is being accompanied by this new disorder.

"We have observed increased instances of this phenomenon," says Dr. Eitan Gur, director of the eating disorder department at the Sheba Medical Center at Tel Hashomer. "There are many people who, in the guise of healthy eating, develop severe eating disorders. They are afraid to admit to a problem, and claim they eat correctly: lots of organic grains, fruits and vegetables," Gur says. "The problem tends to occur among higher socioeconomic classes, because health food is more expensive. There is no one treatment; patients need to work with a dietician to change their menus to include a larger variety of foods, although it is sometimes difficult to persuade them to cooperate."

Over the past few months, medical literature has described orthorexia's spread throughout the western world. Turkish researchers reported in March that it was becoming common among artists: 82% of opera singers, 36% of symphony musicians, and 32% of ballet dancers. Others found the illness among medical students and dieticians.