Athletes, from the fitness-focused weekend warrior to the racing professional, can all benefit from a mindful and attentive approach to what they eat. Training, while very important, is only one part in the fitness and performance equation, while daily nutrition is a significant contributor to an overall healthy lifestyle. Athletes, therefore, tend to take food seriously. Many shop at health food stores, carefully plan weekly menus, and make big batches of this and that on Sunday in order to have nutrient-dense lunches during the workweek. Some non-athletes might look askance at all of the attention and focus given to what those in training eat. However, ask any workout buddies and they will knowingly give a head nod when discussion turns to the empty spot on the store shelf where a favorite recovery drink, snack bar, or gel was out of stock.
Not only do fitness-focused folks work on their daily nutrition at home, they also tend to think about how meals out at restaurants are going to contribute to training. Pushing the bread basket aside or steering clear of the chips and queso in the thick of training takes some resolve, and choosing more healthful entrées can be tough at times when paring down to race weight. What most athletes also know is that the occasional indulgence of smothered enchiladas, onion rings, or ice cream isn’t going to derail an overall healthy diet or fitness routine. But what happens when an athlete starts rejecting offers to socialize with friends over food because the food isn’t healthy enough for training standards? What happens when that competitor loses sight of the fact that eating once slice of pizza with the team does not jeopardize performance in an event that is over a month away?
In 1996, Steven Bratman, M.D., began to write about his personal struggle with an eating behavior that he described as “extreme diet purity” while he was living, working, and cooking on an organic farm. In his original 1997 essay, he came up with a name for this “unhealthy obsession with healthy eating”—orthorexia nervosa. While orthorexia nervosa is not a diagnosable eating disorder per se, it can be considered a disordered eating behavior or an irregular eating pattern that can have significant health consequences, both mentally and physically. This addiction to consuming only the healthiest foods can share some characteristics of obsessive-compulsive disorder but is not necessarily OCD. When food begins to control life, when an eater thinks about little else than the next meal, and when an individual begins to scoff at friends and strangers for the foods they eat (all the while glowing inside because of his or her own perfect adherence to self-selected food rules), this behavior crosses the line from healthy to harmful.
Maintaining a healthy balance in the training diet is critical. It’s important for athletes to be able to distinguish a mindfully focused goal for an upcoming event or general weight maintenance from an obsession that changes interactions with friends, family, and coworkers. Don’t get me wrong; as an athlete and healthy eater, I believe in packing my lunch, making healthy entrée choices when eating out, and loading my diet full of fruits, vegetables, and whole grains. However, I don’t berate myself for the occasional dark chocolate after dinner or choice of fries over a side salad.
While it’s surprising, it’s unfortunately true that there really is such a thing as being too healthy in food choices. I asked Adrien Paczosa, a registered and licensed dietitian with years of experience in disordered eating, to help me explain. Where exactly is the tipping point, where eating healthy becomes unhealthy?
Paczosa offered this insight: “When being careful about what you eat slips to a disorder is when the motivation behind the food choices become skewed or when the rigidity of choices becomes too limited, thus hindering one’s life. For example, choosing to purchase food based on the way it is grown and treated would be appropriate, but when this view begins to bleed into limiting your choices to the point of never eating out…or traveling with your own cooler to a friend’s dinner party could be a warning sign…one may want to step back and see how their eating and relationship with food is affecting their quality of life.”
I remember a friend of mine from my early teens who struggled with this very notion. The list of foods she “allowed” herself to eat was so limited that it affected her social life and even began to cause some health and medical problems. This was in the era when fat-free eating was popular. My friend took this notion to the extreme, basically cutting all of the fat out of her diet. She did this long enough to develop issues with her hair, skin, and nails as well as amenorrhea—a major sign that something was wrong with her body. Even though she knew that adding fat back into her diet was the best choice for her health, it was difficult for her—that rigid rule enforcement was her addiction. And it’s this unhealthy obsession with an otherwise healthy behavior that Dr. Bratman equates to “exercise addiction, or workaholism.” Few would deny that going to work to earn a living and getting an hour of exercise a day are perfectly acceptable behaviors, but an addiction to either can cause major upset in all aspects of a person’s life.
Dr. Bratman described the progression of orthorexia in his 1997 essay: “…orthorexia eventually reaches a point where the sufferer spends most of his time planning, purchasing and eating meals. The ortheorexic’s inner life becomes dominated by efforts to resist temptations, self-condemnation for lapses, self-praise for success at complying with the self-chosen regime, and feelings of superiority over others less pure in their dietary habits. It is this transference of all life’s value into the act of eating which makes orthorexia a true disorder.”
This behavior can also be a detriment to training and exercise. Generally, the human body has the capacity to store about 2,000 carbohydrate fuel calories. This carbohydrate storage is called glycogen and, to put it lightly, it doesn’t last all that long during extended bouts of aerobic exercise. Depending on your pace, training, and endurance, this readily available fuel can last up to a couple of hours. After we deplete our bodies of this previously stored fuel, we need to start consuming calories in order to keep exercising. This is why athletes suck down sports drinks and eat beans, chews, and our favorite gels to make it through long sessions. While it would be nearly impossible to match every calorie burned, most try to take in enough calories to keep muscles firing and brains fueled. If blood sugar levels can be maintained with enough fuel intake, exercise can continue; if not, we hit the dreaded wall and bonk. The occasional bonk is an okay thing but struggling on every run, ride, swim, or climb makes Jack a dull boy.
The act of training without replenishing is called “training low,” i.e. training with a low intake of carbohydrates, thus using stored glycogen and “teaching” the body to burn different fuel. There is much controversy around this concept, and I am not here to argue for or against it. I’d like to use this practice to illustrate a point.
Say you decide that you are going to use the “train low” concept. However, your reasoning is not to teach your body to use different fuel but rather to make sure to maximize weight loss and (you think) good health. Okay, great—but let’s add to that that you have also been restricting your calories and displaying orthorexic behavior on a day-to-day basis outside of training. Due to these daily calorie restrictions, your body is not filling up its glycogen gas tank. Yet you continue to have long bouts of training. At first, shorter workouts seem to be fine but, as time goes on, you find you are hitting up the office coffee pot more and more in the afternoon. The longer weekend sessions are not going well at all. You bonk on every one—no matter if it’s a ten or 18 miler—and you can’t figure out why. You think that perhaps you need to cut more weight to improve your fitness, so you begin to restrict more. This is where things can become a dangerous and vicious cycle. To carry this example to an extreme, blacking out on a long run and needing to be rescued from the trail is not making you healthier.
In the thick of training for my third Ironman, I was doing a solo century ride out to Andice on a day where temperatures were slated to reach over 100 degrees—yeah, 100 miles plus 100 degrees! I knew I needed proper fuel and hydration but achieving that, friend, is easier said than done. Both of my bike bottles containing the majority of my calories were HOT less than an hour into my ride. While I stopped several times to get water and ice, I knew I was not taking in nearly enough calories to be out on the bike for six hours. Eventually I made it to Andice, shakily got off my bike, and walked into the general store, my legs literally wobbling as I went. Thanks to all of my schooling, I knew what I needed to do in order to make it the 50 miles back home. I needed food fast and not just any food—I needed fast-absorbing carbohydrates.
I’m not proud of what happened next (well, actually, I am, sort of). I reached for a candy bar and a big bottle of sports drink, consuming both in record time. Why am I proud of myself for consuming what I would normally consider junk? For exactly that—I considered it junk but knew if I didn’t get the calories in, I wasn’t going to make it home. On any normal day, I have created a “rule” that I don’t eat candy bars and I would not have chosen one. When push came to shove, I was able to break that rule by being able to understand that the need for fast calories (and a way home) trumps any of my self-imposed rules. This thinking is an important part of a balanced training diet, and I would have caused major damage had I not broken my own “rule.” Unfortunately, I know plenty of training buddies who would not have made the same decision.
You may scoff at the notion of orthorexia in a nation that is overwhelmed with an obesity epidemic. The obesity epidemic has been and will continue to be a major focus of our nation’s health, health care system, and economy for the foreseeable future. The problem of obesity has taken over the media and our minds. While it is much more common to be overweight or obese than it is to eat too healthfully or be too thin, we who are living in fitness-focused Austin need to be aware that an obsession with healthy eating can be cause for concern. To quote Sir Francis Bacon, “Knowledge is power.” And knowing what to look for before orthorexia becomes a major health issue is as important as fighting obesity.
How can we as athletes fight orthorexia? Keep an eye out for your training partners. For most of us, our training partners started out as or have become good friends. We train, whether together or alone, to stay in shape and perform at our peak. If you notice your training buddy (or any other friend or family member) struggling with self-imposed food rules and having regular difficulty with training that used to be no problem, it’s time to reach out. Contact a registered dietitian. R.D.s are trained nutrition professionals who can help to create an eating plan that works for specific individuals, all while keeping the individual’s goals and lifestyle in focus. An R.D. will be able to help identify which eating habits and patterns lead in a healing direction. There are many dietitians in the Austin area who focus on wellness, sports, and eating issues who would be happy to help create a personalized plan that keeps you fit, healthy, and most of all, well-balanced.