When “Clean Eating” Crosses the Line: Unpacking Orthorexia in Holistic Health Circles

When “Clean Eating” Crosses the Line: Unpacking Orthorexia in Holistic Health Circles

Picture this: you’re scrolling through a wellness account on Instagram or TikTok, and it dazzles you with perfect smoothie bowls, meticulously labeled “clean” meals, and #wellness experts promising longevity through restriction. On the surface - which is polished, pastel, and perfectly curated - it seems inspiring. But pause to consider: when does the pursuit of health morph into a hidden trap?

A Rising Pattern in a Digital Age

Orthorexia nervosa (ON) - first coined by Dr. Steven Bratman in 1997 - is not about weight, but about purity: an obsessive fixation on the quality of food rather than the quantity. The irony? In trying to be healthy, individuals can alienate social networks, suffer poor nutrition, and harm their quality of life. It’s a pursuit of virtue that, when taken too far, may backfire dramatically. 

We live in a digital era tailor-made for orthorexia’s slow creep. Studies show that Instagram, more than any other platform, correlates strongly with increased orthorexia symptoms. Among health-oriented communities on Insta, almost half exhibited signs of ON - compared to under 1% in the general population. This happens through curated perfection, echo chambers, and algorithmic reinforcement - trending “clean meals” can signal belonging, even when they signal restriction. 

Yet, Instagram and similar communities play a paradoxical role: they can both glorify orthorexic tendencies and support recovery. Some users post candid stories about their journey out of restriction and toward balance, creating pockets of insight, vulnerability, and healing. This duality makes us wonder: how do we differentiate healthy inspiration from harmful zeal?

When “Healthy” Becomes Harmful - Especially Among Practitioners

Here’s a paradox worth reflecting on: people trained in nutrition, functional medicine, clinical nutrition, or naturopathy - those who deeply understand food - appear more vulnerable to orthorexic patterns, not less. A systematic review found that those immersed in health‑professional training are far more likely to show ON traits compared to the general population - especially early on in their education or careers.  

Perhaps the danger lies in expertise: knowing the minute details can lure professionals into perfectionism, moralising diets, and self‑imposed purity rules. In social media spaces where every claim about “toxins” or “detoxes” is amplified without context, this becomes a fertile ground for compounding harm.

While many health professionals have good intentions, it's important to watch for red flags that signal a shift from supportive guidance to restrictive, fear-based messaging. If your practitioner…

• uses overly moral language about food (like "toxic," "dirty," or "clean"),

• encourages unnecessary elimination of entire food groups without medical cause, or client preference

• instills fear or guilt around social eating or flexibility,

• equates health with rigidity or perfection,

• promotes protocols that feel unsustainable, isolating, or obsessive,

• or seems to praise extreme control or purity over balance and wellbeing,

…you may be receiving advice shaped by orthorexic thinking. True health support should leave you feeling empowered, not afraid. It should expand your life—not shrink it.

Trending Questions: Recovery, Plant-Based Diets, and Evolution to Anorexia

How can one recover from orthorexia?
Recovery isn't about returning to the same routines - it’s about discovering flexibility, nurturing pleasure, and learning that health isn’t synonymous with restriction. Experts recommend multidisciplinary support: dietitians, therapists, and freedom to reintroduce variety.

Is there a link between plant-based/vegan diets and orthorexia?
Yes - and it’s complex. A 2025 study found similar traits shared between orthorexia and plant‑based diets - showing a possible vicious cycle where someone inclined toward strict purity might adopt veganism as justification, or vice versa. A 2021 review found that vegetarian diets were linked to orthorexic behaviours in 11 out of 14 studies examined. Another recent cross-sectional study confirmed that vegans and vegetarians exhibited significantly higher orthorexia tendencies than omnivores - and those with ethical motivations, weight control, or mood-related food choices scored higher still. Moreover, vegans showing high orthorexia engage in more restrictive eating and psychosocial avoidance - especially when mindful eating and self‑compassion are low. 

But - and this is important - these patterns don’t mean plant-based eating is inherently unhealthy. Many follow vegan or vegetarian lifestyles for aligned ethics or health beliefs. The risk emerges when beliefs become strict rules without compassion. Healthy orthorexia (an interest in healthy eating) must be distinguished from its obsessive counterpart - to avoid stigma and overdiagnosis.

Can orthorexia lead to anorexia?
Orthorexia isn’t a linear progression to anorexia, but there’s overlap. Some individuals shift from purity-focused restriction to quantity-focused restriction. The rigid mental control that begins with “clean” can evolve into dangerous calorie restriction, social isolation, and severe malnutrition -echoing classic anorexia nervosa patterns. 

Signs of Orthorexia Nervosa (ON)

Orthorexia is an unhealthy obsession with eating "clean," "pure," or "healthy" foods. It is not officially recognized as a clinical eating disorder in the DSM-5, but it is widely studied and acknowledged in functional and clinical settings.

Emotional and Behavioral Signs:

• Obsessive thoughts about food quality, ingredients, or sourcing (e.g. organic, raw, alkaline)

• Moral judgment attached to food choices (e.g. feeling "good" for eating clean or "bad" for eating processed foods)

• Extreme distress or anxiety when “rules” are broken (e.g. eating out, attending social meals)

• Avoidance of social situations involving food

• Constant checking of labels or ingredients, even in foods once deemed safe

• Rigid belief that specific foods or food groups are harmful or toxic

• A sense of superiority or identity derived from food choices

• Increasing dietary restrictions over time (e.g. cutting out gluten, dairy, sugar without medical necessity)

Physical and Social Consequences:

• Malnutrition or weight loss (not always present)

• Lack of dietary variety leading to deficiencies

• Isolation from friends, family, or social eating experiences

• Preoccupation that interferes with daily functioning

Signs of Anorexia Nervosa (AN)

Anorexia nervosa is a serious psychiatric eating disorder recognized in the DSM-5. It centres around food restriction and a distorted body image, often with a desire to lose weight or prevent weight gain.

Core Diagnostic Criteria (DSM-5):

• Restriction of energy intake leading to significantly low body weight

• Intense fear of gaining weight or becoming fat, even when underweight

• Distorted perception of one’s body weight or shape

• Denial of the seriousness of low body weight

Emotional and Behavioral Signs:

• Severe calorie restriction and rigid food rules

• Obsession with body size, weight, and appearance

• Excessive weighing or body checking

• Ritualistic eating behaviors (e.g. cutting food into tiny pieces, eating very slowly)

• Use of exercise, purging, or fasting to control weight

• Withdrawal from usual activities and social interactions

• Feelings of shame, worthlessness, or failure tied to eating or body shape

Physical Signs and Consequences:

• Significant weight loss or failure to meet expected weight gains

• Fatigue, dizziness, or fainting

• Thinning hair or brittle nails

• Amenorrhea (loss of menstrual cycle in women)

• Cold intolerance

• Gastrointestinal issues (e.g. constipation, bloating)

• Slow heart rate, low blood pressure

Invitation to Critical Reflection - Not Just Consumption

As we ponder all this, ask yourself:

• When you see “wellness” content online, does it inspire curiosity or judgment-yours or someone else’s?

• Are you-or your peers or clients-holding beliefs about food that feel liberating, or confining?

• Can our communities support ethical, plant-based living without moralizing it or excluding the messy, joyful parts of eating?

  

At InHer Health Clinic, my core philosophy is that health should never come at the cost of joy, mental wellbeing, or food freedom. As a clinical nutritionist, functional medicine practitioner, and naturopath, I work with women every day who are looking not just for answers, but for relief from the pressure to be perfect. That’s why I do not, and will never, promote restrictive eating patterns, fear-based nutrition advice, or wellness extremes disguised as health.

I believe in balance, not perfection. Food is not good or bad. It's not clean or dirty. It's just food. Your relationship with it matters more than rigid rules, and I support clients to find what truly works for their unique body and their lived reality. Sometimes that means structure, sometimes it means flexibility, but it always means working in partnership with your physiology and your life - not against them.

Food freedom and flexibility are central to my approach. Even in cases where we explore elimination or therapeutic diets, the goal is always to support healing with intention and to eventually bring variety and pleasure back into the picture. I do not believe in long-term restriction for the sake of control. I believe in nourishment that expands your life, not contracts it.

Functional testing can be powerful, but I use it with care. It’s not there to scare you or send you into a spiral of micromanaging every bite. Instead, I use it as a tool for insight and clarity - one that helps us understand your body better, not shame it into compliance. There is no room in my clinic for shame, guilt, or dietary perfectionism.

This is a trauma-informed, compassion-led practice. I’m aware that many women carry a history of food guilt, body image struggles, or even past disordered eating patterns. That awareness shapes everything I do - from the language I use, to the protocols I create. You will never be made to feel broken here. You will be held, heard, and empowered to rebuild trust in your own body.

Body literacy is at the heart of the work we do. I don’t want you to rely on me forever. I want you to understand your body’s rhythms, signals, and needs so deeply that you can advocate for yourself long after our work together ends. When you are connected to your own body wisdom, the noise of diet culture starts to fade.

Everything I do is grounded in evidence-based practice, but also filtered through a lens of common sense, compassion, and sustainability. There is a lot of misinformation out there - even within practitioner spaces - and I am committed to staying curious, self-aware, and aligned with what truly supports long-term health.

If you choose to work with me, you can expect education, clarity, and care. You will never be pushed into extremes. You will be encouraged to enjoy food again. You will be reminded that you’re allowed to rest. You will be given space to heal on your own terms.

This is health without obsession. This is care without control. This is what we do at InHer Health Clinic.

BOOK YOUR FREE INTRO CALL

References

1. Bratman, S., & Knight, D. (2000). Health Food Junkies: Orthorexia Nervosa - Overcoming the Obsession with Healthful Eating. Broadway Books.
   (Foundational text introducing orthorexia nervosa.)

2. Cena, H., & Calder, P. C. (2020). Defining a healthy diet: Evidence for the role of contemporary dietary patterns in health and disease. Nutrients, 12(2), 334. https://doi.org/10.3390/nu12020334 

3. Dunn, T. M., Gibbs, J., Whitney, N., & Starosta, A. (2017). Prevalence of orthorexia nervosa is less than 1%: Data from a US sample. Eating and Weight Disorders, 22(1), 185–192. https://doi.org/10.1007/s40519-016-0258-8 

4. Depa, J., Barrada, J. R., & Roncero, M. (2019). Are the motives for food choices different in orthorexia nervosa and healthy orthorexia? Nutrients, 11(3), 697. https://doi.org/10.3390/nu11030697 

5. Barthels, F., Barrada, J. R., & Roncero, M. (2021). Orthorexia nervosa and healthy orthorexia as new eating styles. PLOS ONE, 16(1), e0243155. https://doi.org/10.1371/journal.pone.0243155 

6. Heiss, S., Coffino, J. A., & Hormes, J. M. (2019). Eating for a healthier you: The relationship between health-conscious eating and orthorexia nervosa in a diverse U.S. sample. Appetite, 140, 114–123. https://doi.org/10.1016/j.appet.2019.05.002 

7. Brytek-Matera, A., Czepczor-Bernat, K., Jurzak, H., Kornacka, M., & Kołodziejczyk, N. (2019). Strict health-oriented eating patterns (orthorexic eating behaviors) and their connection with a vegetarian and vegan diet. Eating and Weight Disorders, 24(3), 441–452. https://doi.org/10.1007/s40519-018-0560-3 

8. McComb, S. E., & Mills, J. S. (2019). Orthorexia nervosa: A review of psychosocial risk factors. Appetite, 140, 50–75. https://doi.org/10.1016/j.appet.2019.05.005 

9. Asproni, G., Avena, G., Saba, L., Doneddu, G., & Ruiu, A. (2022). The dark side of health promotion: The “orthorexic” role of wellness influencers. Italian Journal of Health Education, 15(3), 45–56.
   (Not on PubMed but worth noting for sociocultural commentary.)

10. Turner, P. G., & Lefevre, C. E. (2017). Instagram use is linked to increased symptoms of orthorexia nervosa. Eating and Weight Disorders, 22(2), 277–284. https://doi.org/10.1007/s40519-017-0364-2 

11. Missbach, B., Dunn, T. M., & König, J. S. (2017). We need new tools to assess orthorexia nervosa: A review of the literature on existing assessment tools. Eating and Weight Disorders, 22(1), 1–7. https://doi.org/10.1007/s40519-016-0263-1 

12. Valente, M., Syurina, E. V., & Donini, L. M. (2021). Orthorexia nervosa and veganism: A review of the literature. Frontiers in Nutrition, 8, 716848. https://doi.org/10.3389/fnut.2021.716848 

13. Chard, C. A., Hilzendegen, C., Barthels, F., & Stroebele-Benschop, N. (2019). Psychometric evaluation of the English version of the Düsseldorf Orthorexia Scale (DOS) and the prevalence of orthorexia nervosa among a U.S. student sample. Eating and Weight Disorders, 24(2), 275–281. https://doi.org/10.1007/s40519-018-0570-1 

14. Cramer, H., et al. (2020). Mindfulness and self-compassion in eating behavior: The mediating role of body image acceptance. Eating and Weight Disorders, 25(5), 1237–1245. https://doi.org/10.1007/s40519-019-00737-w 

15. American Nutrition Association. (2022). Orthorexia: The hidden eating disorder among health professionals. https://theana.org