Gluten Free? Think Again

EVERYONE KNEW THAT when they invited Sujata Verma (name changed) home for dinner, they had to be extra careful with the menu. Vegetables had to be organic and seasonal. They had to be washed in an ozone vegetable cleaner and cut using knives that had been sterilised in boiling mineral water. There could be no fat, gluten, lactose, fructose, soy or sugar in the food. She insisted on only organic Himalayan rock salt on the table. There could be no cheating. Verma would make sure she was in the kitchen while the food was being prepared. Close friends and family tolerated this obsession with eating healthy. Her mother boasted to everyone in the neighbourhood how ‘body conscious’ and ‘aware’ Verma was. But colleagues and partners slowly started avoiding her. To them, increasingly, she was just plain crazy.

“Health became important to me by the time I was nine. I remember all the other kids in school would eat Maggi and ketchup sandwiches in white bread. I would insist on a kachumber salad with roti or carrot sticks with raita. My teachers would praise me and all the other parents would cite me as the poster child for health. I enjoyed that, I still do—the attention, the feeling of being better than the rest,” she says. By the time she turned 28, Verma, a marketing executive based in Delhi, was spending 90 per cent of her salary on organic and artisanal food, gym memberships and vegan cleanses. “People said I was obsessed with health food. I thought they were jealous.”

In 2014, at the age of 31, Verma was diagnosed with osteoporosis from low vitamin D and Kwashiorkor, a disease called by severe protein-deficiency. “It was the greatest shock of my life. I remember lying in bed in the hospital gown and wondering how this could be happening to me. I had kale smoothies every day,” she reflects. Several consultations with nutritionists at Medanta hospital in Gurgaon followed where it was discovered that she had been cutting down key food groups for the last 15 years. Milk, whole grains, pulses, fruits like apples and oranges, iron-rich vegetables, eggs, gluten—anything that she considered ‘unclean’.

Verma’s wasn’t your average eating disorder. She wasn’t anorexic, bulimic or obese. She didn’t eat under stress, when she was sad or to manage anger and anxiety. She didn’t suffer from Obsessive Compulsive Disorder (OCD) or any other psychiatric ailment. Instead, hers was a constant preoccupation with the virtue of food, the moral platform on which health placed her. She was one of the first to be diagnosed with Orthorexia Nervosa in India, an eating disorder where patients suffer from a qualitative obsession with health food.

In an age of clinically-prescribed raw food diets, gluten- free atta delivered to your doorstep and snapchats of lactose- free ice cream in the hands of thin, beautiful women, more and more Indians are now making diet choices that they perceive as healthy. But as nutritionist Dr Poulami Dasgupta discovered in her first pilot study on Orthorexia in India, nearly 100 per cent of the test subjects did not even realise they were suffering from a chronic obsession to eliminate unhealthy food. But what they saw as unhealthy had no rational, clinical or medical basis. Their notion that healthy is good, and what healthy itself is, was mostly derived from magazine articles and social media. In the study (‘Orthorexia: A Review’) Dasgupta’s findings indicated that 56.7 per cent of the group displayed orthorexic symptoms, most of these were female, under 25, highly qualified and belonged to a higher socio-economic background. “The study also discovered that 60 per cent of nutritionists in the group showed orthorexic symptoms themselves—swearing by certain foods and advising their patients to completely cut out the rest,” says Dr Dasgupta, who has worked as a nutritionist at Medanta and is now considering pursuing a PhD on orthorexia in connection to the brain. “There is a hypothesis that orthorexics have an imbalance in serotonin or pleasure hormone levels in their body. We’re hoping that understanding the link between the brain and the gut will help us see orthorexia in greater detail.”

The clinical discovery of orthorexia is important because it’s been lying on the periphery for a while now. Nearly 19 years after the term was first coined by Dr Steven Bratman, the disease remains unclassified and is yet to be listed in the widely-accepted psychiatric journal, Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. “Orthorexia overlaps with bulimia and anorexia and that makes it harder to treat and define. It’s main differentiating factor is that patients focus on quality of food and not quantity,” explains Dr Dasgupta. However, the lobby to push for its recognition as a mainstream eating disorder has grown significantly in the last few years. There are several authors, bloggers, recovering patients and nutritionists who feel that moderate healthy eating habits need to be taught to people at large who increasingly use #health to convey a certain image of themselves.

“It scares me, because there is nothing wrong with being healthy, but the way that culture has developed these days, being healthy is more about performing as healthy for other people. And that performance becomes an identity: ‘Like me because I am a healthy role model.’ More and more people get their entire identities caught up in whether or not they have put out a blog post or a podcast about their latest health discovery or instagrammed their #glutenfree meal for others to gaze upon,” says Kaila Prins, a recovering orthorexic and author of Finding Our Hunger. Kaila was living in New York City when her obsession with health food turned her suicidal because the need to eat right was taking over her entire life. At one point, she was ready to drop out of college because it interfered with her ability to stay at home and cook her own food. Harder still was the time it took for her to realise and own up to her orthorexic symptoms.

“There’s not a lot of education about what an eating disorder actually ‘looks like’. The way the media works, we only see the most extreme examples of anorexics and maybe sometimes bulimics, but if you don’t fit into what the cultural expectation of an eating disorder looks like, there’s a good chance that you won’t believe it if you have one,” she says. “In that same vein, the eating disorder lies to you and tells you that you’re not sick enough to receive or deserve help. In addition, there is still a stigma about having an eating disorder. I talk about it freely, because I want to reduce the stigma, but I know that I am in the minority. And finally, most people don’t know that there are other eating disorders besides anorexia and bulimia. You can’t admit to something you’ve never heard of, and so when people are told they have a problem by others who care about them, they can’t understand it,” explains Prins.

Dr Dasgupta too faced similar problems while conducting her study on orthorexia. Nearly half the subjects she had gathered backed down because they were uncomfortable about confronting the truth. She says, “They believed that I was trying to make health food look bad. But that is not the case. Moderation is key to everything. Why are so many people cutting out gluten from their diet today? Gluten is an important protein. If you don’t suffer from an allergy, why would you skip an essential food item? It’s because we have placed health on a pedestal, it’s seen as something righteous, socially-acceptable, principled—instead of simply incorporating it into our lifestyle.”

AFTER WRITING ABOUT orthorexia in Health Food Junkies: Overcoming the Obsession with Healthful Eating, Dr Bratman went on to publish several other books on the subject. Today, he has a scientific definition for the disease (‘An unhealthy fixation with what the individual considers to be healthy eating’) and is working on getting this accepted by the medical community. However, it could be years before orthorexia gains the same level of awareness as anorexia or bulimia, both of which took around 80 years before they were listed in the DSM. ‘All illnesses derive from a combination of biology and environment. The same is true of eating disorders. Orthorexia is not new—one can find evidence of it going far back in history. It is much, much more common today, but that is presumably mostly because in the modern era a far higher percentage of humanity has sufficient food to pick and choose,’ says Dr Bratman in an email interview to Open. ‘There is one specific characteristic feature of orthorexia that goes the other way: followers of extreme diets commonly evangelise on behalf of their favoured diet, trying to convince everyone they know to eat the same; people with other EDs most often hide their diet from others (though there are some exceptions).’

Some feel that celebrity endorsement or a high-profile orthorexic patient speaking out could be key to getting the disorder the attention it deserves, in the same way the cases of Princess Diana and Victoria Beckham put the spotlight on bulimia and anorexia. After all, orthorexia can be just as dangerous. The disease isn’t just about becoming socially alienated or battling psychiatric and emotional scars. In some cases, like that of Kate Finn in 2003, orthorexia can even prove fatal. “A simple, average, home-cooked diet will work wonders. There is no need to stuff your larder with goji berries, quinoa, cocoa nibs, chia, acai berries, and what not. I have seen patients who are convinced that black quinoa is healthier than the white variety, when in fact there is not a difference between the two except for the colour,” says Dr Prabhu Rao, a psychiatrist consulting with Apollo Chennai. “Orthorexics in India are fairly uncommon because nobody thinks that there is anything wrong with eating lots of health food. I have seen a few borderline cases where patients feel a superiority complex and walk away from meals that they perceive as unhealthy. There’s never a clear definition of what’s healthy to them; one person will say he only wants to eat chillies, another will say that too many chillies lead to cancer, and so they only eat green capsicums,” adds Dr Rao.

The most common course of treatment for those who do make it to the doctor is emotional intelligence management and behavioural therapy. According to Prins, “There is no available clinical treatment because there is no clear-cut clinical definition. Some psychologists want it classified as an eating disorder and others believe that it is a psychiatric disorder, like OCD. My recovery came when I started removing myself from the communities that taught me about how to eat ‘healthily’. I stopped listening to the podcasts, stopped following the social media, stopped reading the blogs, unsubscribed from all of the magazines and newsletters, and even stopped going to a traditional gym, so I wouldn’t have to be around people talking about their diet and health all the time. I did what I call my ‘discovery’ (instead of recovery), where I figured out what else I wanted to focus on. It took a long time, but now I don’t think about food because I have other things to focus on.”

Verma is still going for her counselling sessions in Gurgaon. At her therapist’s office, she talks about neglect and insecurity, how she feels giddy with pleasure if anyone calls her healthy, how health has become her identity. “That picture of skinny overnight oats for breakfast, that was me. That was who I wanted to be. I wanted to tell the world that I am confident and I love my body,” says Verma. She’s trying now to find another identity for herself, to define her life in ways that go beyond chia pudding and green tea shots.

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