We've all witnessed the latest trend in nutrition – the various versions of a "free from" diet. That is, Americans are increasingly defining our diets based on what we exclude. Gluten free, vegan, paleo, raw ... there are limitless dietary restrictions that we adopt – whether by medical necessity or personal preference – in establishing what we believe to be the healthiest diet for us.
In other words, there are cases in which a dietary pattern that looks healthy on paper results in poor health outcomes in practice. Here are a few examples:
• The junk food vegetarian. Plant-based diets get lots of good press – and for good reason. Yet, I've met countless vegetarians who don't actually eat vegetables. There was the vegetarian colleague whose lunch staple was macaroni and cheese with Diet Coke. And then there was a vegetarian patient whose four food groups were bread, cheese, potato chips and French fries. I once met a vegan family whose young child subsisted on apple juice, white flour baguettes and animal cookies. In all of these cases, excluding meat hardly resulted in a health-promoting dietary pattern.
To be sure, a well-planned, plant-based diet is arguably among the healthiest eating patterns one could adopt. My college roommate – a vegetarian – is easily the healthiest eater I know: Her kids beg to snack on cherry tomatoes and sugar snap peas, and they devour nutrient-dense, homemade dinners of seaweed salad, beans, tofu and kale. But the key takeaway here is to recognize that vegetarian diets come in all shapes and sizes—and the exclusion of meat or animal foods does not necessarily a healthy eater make.
• Orthorexia: socially-sanctioned disordered eating. There are cases in which people adopt a highly-restricted diet under the pretense of wanting to "be healthy." They may eliminate multiple food groups, become extremely rigid in their eating habits and obsess over each and every morsel that passes their lips for fear that something "unhealthy" could slip in.
This preoccupation with righteous eating morphs into a very unhealthy relationship with food that has been informally termed "orthorexia." I've seen such patients adopt a variety of dietary restrictions – vegan, sugar-free, raw, gluten-free, dairy-free, paleo – and often a combination thereof. Unlike those who follow these diets in hopes of achieving optimal nutrition and health – and put in great effort to plan and consume a balanced diet – people with orthorexic tendencies hide behind these diets as a socially acceptable excuse to restrict their eating.
After all, a person who eats superfoods like kale salads, nuts and fruit every day while avoiding processed foods and sugar would seem the portrait of dietary perfection. And you certainly can't blame a vegan for not ordering anything at a restaurant when the menu is so unaccommodating. This is precisely what makes orthorexia so insidious: On the surface, the commitment to "healthy eating" is unimpeachable. And yet, people with orthorexia are hardly enjoying robust health or a good quality of life. My orthorexic patients tend to be underweight, sometimes dangerously so, are terrified of liberalizing their diet for fear of gaining and often suffer from signs of mild malnutrition like hair loss, brittle nails and always feeling cold.
• The empty-calorie weight-loss plan. On occasion, I'll see patients following a commercial weight loss program like Weight Watchers or Nutrisystem. And as we review their daily food journals, I'm generally dismayed to see entire diets that consist of highly processed, empty-calorie carbs – like frozen pizza or pasta entrees, snack cakes and calorie-controlled ice cream bars. (If the points fit, eat it!)
To be sure, these patients continue to lose weight or maintain their losses so long as they stick to the plan's portion control protocol. But their risk for adverse diet-related health outcomes – like type 2 diabetes or certain cancers – may not improve nearly as much as one might expect based on their weight-loss success.
These cases are a great example of why weight alone is not necessarily an adequate indicator of health or diet quality. After all, most overweight people could achieve a healthy weight if they were restricted to just 1,000 calories per day from potato chips. But as the result of this one-dimensional high-carb diet lacking in fiber, fruits and vegetables, their nutrition status would be compromised and their health prospects dimmed. When it comes to weight loss for health, the means to the end can be as important as the end itself.
I, for one, have seen a multitude of healthy diets – some of which have included meat and others that have not; some of which have included dairy, and others that have not; some of which have included grains or gluten and others that have not.
Jean Brillat-Savarin, an 18th century French politician and foodie, famously said: "Tell me what you eat, and I will tell you what you are." Indeed, he recognized that one can tell a lot about a person by observing what they actually eat – not what they choose to exclude.
[Read: Recipe for Health.]
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Tamara Duker Freuman, MS, RD, CDN, is a registered dietitian whose NYC-based clinical practice specializes in digestive disorders, Celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.