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What is orthorexia?

It's not in the DSM, but it's still real. Orthorexia involves a paradoxically unhealthy obsession with so-called healthy eating

Though it does not appear in the Diagnostic and Statistical Manual (DSM), there is a form of disordered eating that may go undetected, because it appears so benign: orthorexia, an unhealthy obsession with so-called healthy eating. Like other mental health disorders, the causes of orthorexia are unknown, yet it can be linked to anorexia and bulimia. Athletes of both sexes are particularly susceptible, because there are so many issues around fuelling for training and performance.

Image of a young woman running hard on the road.

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Eating a healthy diet is obviously desirable. Figuring out what constitutes a healthy diet can take many athletes (especially younger athletes) down an unhealthy path into orthorexia and other eating disorders if they lack correct information about nutrition–believing carbs and fats are unhealthy, for example, when they’re actually critical for maintaining energy stores. Or out of a desire not to gain weight, so as to maximize their performance on the track.

Orthorexia may accompany other forms of disordered eating, such as anorexia nervosa (leading them to restrict permissible foods to green vegetables, for example, or fruit). It may also be linked to obsessive-compulsive disorder (OCD). The British organization #TRAINBRAVE claims athletes are 20 per cent more likely to develop disordered eating than the general population. Disordered eating and RED-S are likely to result in bone injuries due to the loss of bone density resulting from a caloric deficit.


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Wanting to avoid unhealthy food is not, in itself, unhealthy. Many athletes avoid junk food and highly processed food most of the time, and for good reason. But unlike someone with orthorexia, they don’t beat themselves up when they occasionally eat burgers and fries, pizza, or a sundae after a hard workout. Avoiding anything considered an indulgence or treat may be unhealthy if it’s accompanied by anxiety, obsessive behaviour, or an overwhelming feeling of being out of control.

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Experts who treat athletes are becoming more aware of orthorexia as one of the many subtle factors that may be present in athletes dealing with bone health issues arising from RED-S (relative energy deficiency in sport) and disordered eating.

Renee McGregor is a dietitian and cofounder of #TRAINBRAVE, the British organization created to raise awareness of RED-S in athletes. She is the author of a number of books on the subject, and has also just announced the opening of a new private clinic in Bath, UK to treat athletes dealing with RED-S and eating disorders.

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ARE YOU READY TO TRAIN? I’m a big fan of monitoring; ask any athlete I have worked with and it’s fundamental to my practise. If you really want to get the most out of someone’s performance, you have to understand how their body is responding to their training load and only then you can provide them with appropriate nutritional interventions. So what do I mean when I talk about monitoring? Sleep, yes absolutely. There are numerous studies linking the importance of sleep in recovery but if your body is in a chronic stressed state, either physical or mental, this impacts your body’s ability to have a decent night’s sleep. I also encourage athletes to rate their energy levels (subjective I know) and their motivation to train. This can tell us a lot about their physical and psychological status. However, I go one step further. My biochemistry and clinical background in nutrition has always meant that I have a real interest in what’s going on within the body and for this reason. I’m a big fan of monitoring biomarkers, or more simply put, bloods values of key markers that can tell us about immune, bone and hormonal health; inflammation and thus their readiness to train and compete. Looking at specific blood biomarkers can help to ascertain what is really going on within the body and then you can provide appropriate advice specific to that individual. Many of us think we are invincible, especially when training and racing is going well but to perform optimally you have to be mindful that the body also needs periods of rest and consolidation. #optimalhealth #happymindhealthybody #trainbrave #En:spire #biomarkers #sportsperformance

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If you suspect you may have an issue with orthorexia, talk to your coach or family doctor, who should be able to put you in touch with medical experts and resources for treatment.