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ОглавлениеPicky Eaters—Orthorexia and the Hygiene Hypothesis
Water surges, only to overflow.
—CHINESE PROVERB
Things turn into their opposites when they reach their extremes. And “healthy” eating is moving in that direction.
There are good reasons that we have food on our minds. According to the U.S. Centers for Disease Control and Prevention (CDC), half of all Americans have a chronic disease or condition such as high blood pressure, heart disease, or type 2 diabetes and have been instructed to think about fat, sugar, and/or salt. More than 9 percent have diabetes and must monitor their sugar/glucose intake multiple times every day. At least 35 percent of Americans are obese and cycle through different diets, gaining and losing weight every year. About 1 percent has celiac disease and avoids gluten. Up to 15 million people in the U.S. have a food allergy, estimated to affect 1 in every 13 children under the age of 18. A study by the World Health Organization reported that noncommunicable diseases were responsible for 86 percent of all deaths and 77 percent of the disease burden in the European Region and noted that this primarily included conditions caused by high blood pressure and cardiovascular diseases. Three of the priority interventions recommended were dietary.
Unfortunately, the National Eating Disorders Association notes that 20 million women and 10 million men suffered from a clinically significant eating disorder at some point in their life, including anorexia nervosa, bulimia, binge eating, or an eating disorder not otherwise specified. In the UK, a National Health Service (NHS) study estimated that more than 725,000 people are affected by an eating disorder and that eating disorders can affect people of any age.
The current obsession with food is not surprising; mankind has been on some kind of restricted diet—by need or choice—since the beginning of time (see Appendix A), but for some it has taken a turn into the obsessively unhealthy.
Orthorexia Nervosa—Healthy Eating as a Disease
Food is an important part of a balanced diet.
—FRAN LEBOWITZ
I don’t like anything “lite”—that’s not my thing. I have one friend who goes to a chiropractor who tests you, and they take one thing after another out of your diet. He evaluates what you eat and decides what foods your body is not tolerating. She’s currently living on kale.
(ILYSSA, 39)
The focus of the press and social media on “healthy eating” as the source of, or cure for, disease has taken hold to the point of creating a new condition termed orthorexia nervosa. Individuals eliminate one healthy food after another (gluten, corn, soy, meat, dairy, all fats, carbohydrates, etc.) in the belief that these foods are “unhealthy”—until they are barely receiving adequate nourishment. It can reach the point of anemia, bone loss, vitamin depletion, and malnutrition.
The condition is not as yet recognized in the DSM-V (the Diagnostic and Statistical Manual of Mental Disorders, used professionally to diagnose psychiatric disorders) but is being seen by many doctors evaluating patients for symptoms related to nutritional deficiencies.
The term orthorexia was coined by Dr. Steven Bratman from the Greek ortho (correct or proper) and orexis (hunger or appetite). Unlike in anorexia, those with orthorexia focus on the quality rather than the quantity of food eaten. They start removing foods because they do not feel well, and when they do not feel better, they remove more and more until they are on an overly restricted and generally unhealthy diet.
Are You Orthorexic?
Have you eliminated entire food groups from your diet? (Gluten, dairy, corn, and soy are the usual suspects as well as red meat, carbohydrates, etc.)
Three or more food groups?
Do you constantly worry about which foods may be unhealthy?
Do you feel guilty when you eat food you consider unsafe?
Do you have problems finding healthy foods?
Do you have ritualized eating patterns?
Are you anxious when eating out or traveling?
Have you started avoiding lunches, dinner dates, and catered parties?
Do you lecture your friends and family about unhealthy eating?
Do you read medical journal articles about digestion, carbohydrates, protein, etc.?
Do you challenge others who disagree with your food choices?
Do you wish that you could just eat and not worry about the quality of foods?
Do you have symptoms that do not fit any medical diagnostic category for which you blame gluten, dairy, or a specific food?
Orthorexia affects a small percentage of individuals, but is yet another food-related disorder that has evolved from the increased focus on food as cause and/or cure for symptoms and disease.
The Hygiene Hypothesis—Are We Too Clean for Our Own Immunological Good?
My daughter-in-law sterilizes everything that goes into my grandson’s mouth. I raised four children on the 10-second rule—if it’s been on the floor for less than 10 seconds, pick it up and eat it—and not one had an allergy or food issue. Now we’re boiling the baby’s fork and spoon after it comes out of the dishwasher, and every other person’s child is allergic to peanuts or dairy or gluten. Something’s wacky here.
(GERI, 64)
The diagnosis of allergies and autoimmune diseases has risen dramatically in the last few decades. While there are many underlying and complex mechanisms at work, a great deal of scientific interest is being focused on the “hygiene hypothesis.” This states that childhood exposure to germs and certain infections helps the immune system develop normally, and that excessive cleanliness interrupts this process.
In other words, the young child’s environment can be too clean to effectively challenge a maturing immune system. Frequent and repeated exposure to a variety of microbial antigens and infections may lead to a more robust, i.e., healthier immune system.
While it is well documented that avoiding germs helps prevent the spread of infections, the hygiene hypothesis suggests that we have taken this too far. And with the advent of antibiotics and the great public health efforts of the last century, the immune system is no longer required to fight germs as actively as in the past.
Scientists based this hypothesis in part on the observation that, before birth, the fetal immune system’s “default setting” is suppressed to prevent it from rejecting the mother’s tissue. This is necessary before birth—when the mother is providing the fetus with her own antibodies. After birth the child’s own immune system must take over and learn how to fend for itself. But the extremely clean household environments often found in the developed world do not provide the necessary exposure to germs required to “educate” the immune system so that it can learn to launch its defense responses to infectious organisms.
A critical part of this evolution is orchestrated by a child’s developing microbiome, and a lack of diversity—reduced by exposure to fewer germs and infections—derails the period of immune growth after birth.
The hygiene hypothesis has been implicated in the growing number of people with allergies, autism, and autoimmune diseases.
MacDonald’s Farm Had the Right Idea?
Since the hypothesis was first proposed by epidemiologist Dr. David Strachan in 1989, several studies have revealed a reduction in the sensitivity to allergens and atopic (skin) disease in children exposed to farm environments, those who have animals in their homes, and in those who have attended day care at an early age and were exposed to other children’s infections.
Several lessons have come from studies comparing populations in Russian Karelia and neighboring Finland. These two populations live in completely different socioeconomic circumstances—they have one of the largest socioeconomic discrepancies in the world—yet share similar diets and genetic backgrounds.
The researchers determined that the children in Karelia are exposed to a large variety of different microbial infections that are significantly less frequent in Finnish children. Starting in 1999, numerous studies on autoimmune and allergic diseases show an incidence of type 1 diabetes that is six times lower in Russian Karelia. The incidence of celiac disease is 1 in 496 in Karelia and 1 in 107 in Finland using identical criteria. These studies appear to indicate that environmental factors play a role in our immune reaction to microbes and in the development of allergies and autoimmune conditions. While all of the factors initiating these conditions have not been identified, the hygiene hypothesis offers an intriguing approach.
The mechanisms by which microbes can reduce the development of autoimmune disease are not well understood. They are only part of a larger autoimmune and allergic response that is also affected by your genetic makeup, and a variety of factors that occur over a person’s lifetime. It cannot be considered the sole determinant of a disease.
Before people start feeding their children from the floor or allowing them to share the dog’s bowl, it should be stressed that many researchers feel that the hygiene hypothesis is far too simplistic an approach to understanding the causes of celiac disease or any other autoimmune disease.
This hypothesis does focus attention on the impact of microbes on disease, hopefully without discouraging good hygiene practices.
BOTH ORTHOREXIA AND the hygiene hypothesis are extreme examples, yet they illustrate what can happen when individuals become mesmerized by the message, and the human body is deprived of the many forms of nourishment it requires to develop, grow, and flourish. Both advanced in the name of “health.”
What we deprive our body of is every bit as important as what we feed it.
