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Eating disorders


While proper nutrition and adequate quantity of foods in balanced proportions is essential to good health, many myths and obsessions in the choice of foods are responsible for poor health and lack of palatability and enjoyment of life. A well known condition is ‘Anorexia Nervosa, prevalent among young girls, who give up foods almost completely to improve their looks and body image. Any amount of counseling may not work on such persons and they get emaciated by voluntary fasting. Another condition that has come to our notice recently is ‘Orthorexia nervosa’. ’ It has been defined as a “pathologic obsession with proper nutrition,” including a strict avoidance of food believed to be unhealthy or impure, that can have serious nutritional and medical consequences. Another group of patients add too many herbs/chemicals in the foods/drinks/tea etc in a belief to enhance its medicinal or nutritional value. They will serve such a food or drink to their guests/friends with lot of verbal jargon to convince them about the miracles that food carries, even after the guest has protested about its taste. Unlike anorexia nervosa, body image is usually not a focus for patients with this condition. A well educated lady will make all excuses to avoid chapattis/rice and will be content with a cup of limca along with 2 spoons of corn flakes. She had concluded that her teeth cannot chew anything and the teeth cannot be treated. She would boast of the energy this combination provided her, while advocating plenty of cereals, dairy products, fruits and vegetables for others. Another patient a male in his 80s would pour into himself several cups of concoction of several condiments and appear to enjoy the distasteful mixture that would give him severe acidity as well. I also recall the case of a 54-year-old man who presented at the emergency department following a 3-day water fast, which he underwent because of a belief in “health stuff, herbs, and a super-healthy diet.” The patient was experiencing metabolic acidosis and severe nausea.

Spiritual Purity and Miraculous Maids

Although the term “orthorexia nervosa” first appeared in the literature in 1997, its leading symptoms have been around for much longer. During the middle Ages, self-starvation was employed as a way to achieve spiritual purity, and during the Renaissance, “miraculous maids” were said to have uncommon abilities to starve themselves. Today, “we are faced with updates on the latest food diet, warnings about certain foods and products, and an ever-changing set of guidelines on how to live a healthier life,” write the investigators. “In this complicated cultural environment, many individuals find it difficult to not worry about their eating habits.” Apparently a movement of “eating clean” and practicing a holistic lifestyle is going on, which has given birth to several wrong mindsets and myths. “Sugar-free, gluten-free, non-GMO, no pesticides, grass-fed – companies are bombarding consumers with these labels. sales of organic foods has doubled between in the recent years.. An obsessive focus on all of this can lead to orthorexia nervosa, which is characterized by a restrictive diet and ritualized eating patterns.”Simply put, orthorexia is a fixation on food quality as opposed to food quantity.”  “The social and cultural context could promote certain types of food intake management that ultimately becomes pathological in a person genetically predisposed to eating disorders.” Although orthorexia is often misdiagnosed as anorexia, patients with the former often flaunt their eating habits instead of hiding them, especially on social media. A doctor added that the condition also overlaps with obsessive compulsive disorder, obsessive compulsive personality disorder, and somatoform disorders.

Two case reports were presented in a discussion. The first patient was a 72-year-old Buddhist nun who presented with extreme weight loss. “You get afraid of eating because you don’t know what it’ll do to you,” said the patient. “Eventually I was afraid to do anything, so I did nothing.” This patient’s mother had unusual beliefs about eating and started eliminating certain foods herself when she was in her 20s. In later years, the patient met with a holistic medicine specialist, who diagnosed her as having multiple food allergies and recommended that she increase her use of food supplements. Treatment for the patient, included a gradual reintroduction of all types of food into her diet and discussions to help her recognize her obsessive thoughts.She starting eating a wide variety of food, including those she once thought would hurt her. She reported being happy with her new curves. The second case: a young woman in her 30s who was severely underweight, hypokalemic, and dehydrated upon presentation. After a psychiatric evaluation, she was prescribed olanzapine 5 mg once nightly and lorazepam 0.5 mg three times per day and was admitted to the hospital.  During early treatment, she only wanted organic coconut water because she believed she had parasites in her gut. Total par-enteral nutrition was initiated to maintain her health. Psychotic symptoms included paranoia as to whether her food had been contaminated, fear of mistreatment by staff, performance of several rituals regarding eating and food preparation, and what appeared to be hallucinations. Her dose of olanzapine was titrated to 20 mg. Haldol, titrated up to 20 mg, was substituted when the first medicine was ineffective. Soon after, the patient started eating more foods and eventually consumed full meals.

“Where do you draw the line for orthorexia, especially in the culture that we’re living in?” asked a participant. “We all know people who have certain preferences. Even in here I’m sure some colleagues would say a plant-based diet is a healthy way to go. ”  It will depend, whether such impairment is in the form of high levels of distress, deficits in functioning, severe malnutrition, or unintentional weight loss.


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