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Are You Too Healthy for Your Own Good?

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You work out and eat right to get or stay in shape, but there's a fine line between being disciplined and letting your commitment turn compulsive. Here's what you need to know about a stealthy new disorder affecting women.

Gone Too Far

When Natalie Mae* was struggling to become pregnant three years ago, she was willing to do anything to up her chances, including heeding a fertility doc's suggestion to lose 15 pounds to reach her ideal BMI. "I started hitting the gym every day for two to four hours, eating healthier foods and counting calories religiously," she says. She pushed herself so hard that she passed out at work and had to be taken to the ER in an ambulance -- twice. "Because I was a little overweight, doctors never asked me about my eating or exercise habits," recalls Natalie, now 31 and a teacher in Tucson, Arizona. "Finally, I became so frustrated -- I was doing all the right things but still wasn't pregnant -- that I asked for a referral to a dietitian." Food and workout logs in hand, she went to the appointment assuming she'd be told how to eat less and exercise more. Natalie was shocked by the dietitian's response. "She said that she wasn't worried about my eating too many calories; she was concerned that I wasn't eating enough. She explained that I probably had an eating disorder and an addiction to exercise," she says.

At her lowest weight of 125 pounds, 5-foot-2-inch Natalie looked perfectly healthy, but she had made herself mentally and physically sick in order to attain that ideal number. Doctors have begun to refer to this sort of problem as orthorexia, or overly correct eating.

"Orthorexia is a new illness with many gray areas," says eating disorder specialist Ira Sacker, MD, a FITNESS advisory board member. "Orthorexics often also suffer from exercise addiction and may have symptoms that overlap with anorexia and bulimia." It's such a new phenomenon, it has yet to be included in diagnostic manuals. But one aspect of orthorexia makes it clearly different from other eating disorders: "While anorexics and bulimics typically recognize that their behaviors are harmful and feel shame about them, orthorexics believe they're doing something good for themselves," explains Jodi Krumholz, RD, the director of nutrition at the Renfrew Center of Florida, an eating-disorder treatment clinic in Coconut Creek.

Since 2008, the number of hospital stays for eating disorders other than anorexia and bulimia -- known as "eating disorders not otherwise specified," or EDNOS -- has grown by 30 percent, with the highest proportion of cases among adults ages 18 to 44, according to the federal Agency for Healthcare Research and Quality. Some experts see a link between the trend and the emergence of orthorexia. "It's a big problem for a lot of women in their twenties, thirties, and forties," says clinical psychologist Margo Maine, PhD, a FITNESS advisory board member. "They start off with the best intentions, eating healthy foods and working out, then a compulsive pattern develops and turns into a true disorder." When that happens, the organic-food aisles and fitness studios that most of us breeze in and out of become the center of an orthorexic's life. "I've seen women who belong to multiple gyms so that they can take several exercise classes a day," Krumholz says. "Others will swear off one 'unhealthy' ingredient after another until there's barely anything they feel safe eating."

The same women who seem admiringly disciplined about their raw-food diets and 5:00 a.m. runs can be dangerously out of control. "An orthorexic will often be so convinced her behavior is healthy that she doesn't realize she needs help until her fixation on food and exercise takes a terrible toll on her body or starts to destroy other aspects of her life," Krumholz says. The more restricted an orthorexic's diet, the less likely she's getting the nutrition she needs, which can trigger a host of health problems, including anemia, hormonal dysfunction, low blood pressure and heart failure. "Unfortunately, instead of feeling exhausted because of overexercise and lack of nourishment, the thrill of control often fills orthorexics with energy and excitement, driving them to push harder to the point of injury or severe illness," Dr. Sacker says. As their obsession grows, so does their eating disorder -- approximately 40 percent of people with EDNOS go on to develop anorexia or bulimia within two years. The good news: You can stop orthorexia before it reaches that point.

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