Orthorexia is not so much an uncontrollable aversion to salt, sugar, fat, and preservatives, as an obsession with diet in general that threatens not only such inessentials as social drinking, but all social interaction, means of livelihood, and often health and life itself.

Orthorexics generally start by cutting out the nasties above, or by deciding to "go meatless" for a while, often as much out of a vague sense of ethical malaise with mainstream society as a health concern per se. With many people, their strictures remain fairly flexible: the Saturday-night steak, the poker night deli sandwich, the evening of comfort food when things aren't working out -- all these tend to remain a part of their lives, albeit somewhat ruefully. With orthorexics, however, the change in diet becomes, not simply a change in what they're eating, but a whole new identity based around food.

Vegetarianism, or wanting "clean food" (though it's unclear why food that may harbor coliform bacteria is "cleaner" than that touched by chemical fertilizer) is just the start: while it would seem harmless and easy to find like-minded people to dine with, the truth is that the health-food subculture is a deeply divisive one, where status accrues not to the healthiest, but those with the most extreme and unusual diets. Cutting out pork rinds and greasy burgers isn't enough, they learn: one must cut out fish, especially shellfish, eggs, milk, and cheese. Or is it? Well, best to become vegetarian to stay on the safe side. Better make it vegan. A day spent without animal products begins to seem as holy and virtuous as one spent comforting the dying, with the kitchen a temple of sancticity, purged of everything that has ever touched an animal product.

Or is it? Soon, while chowing down at a vegan potluck, they hear that avocadoes, olives, and nuts are full of fat, and shouldn't be eaten either. Or that raw food is far more preferable than the horrors of eating burnt and boiled plant carcasses -- plants should be eaten alive, for maximum benefit, and dried beans, grains and nuts (again) are no more 'healthy' than carrion. Or that onions and garlic are the cause of sexual distress, or that plants of the "deadly nightshade" family (tomatoes, peppers, and potatoes) are full of toxins, or that most salad greens have several times more pseudo-estrogens than found in plastic...by simply cutting out one or more of these foods, the speaker themselves found themselves feeling much, much better than they were when they were ingesting these toxins. Yes, yes, the heads nod...we only wish we could be that virtuous. Such tales are often buttressed by references, not to scientific studies, but to dietary taboos of exotic cultures: Nature speaks to these people, we've lost our ability to listen. (The health and longevity of people in these cultures is never doubted, or even asked about...this is spirituality we're talking about.) Environmental toxins and allergies are discussed indiscriminately: it's not only virtuous to purge one's body of toxins, but one's whole home as well, using only approved cleaning products and even light bulbs. Soon our orthorexic decides to try this for themselves.

It's at this point that the diet begins to turn on them: not only are they concerned about food to the exclusion of most other activities, but they aren't feeling as "clean" or as healthy as before. It must have been the french fry they bummed from their old friend at MacDonald's last week, watching him pig out on dead castrated bull. Or the salad dressing they ate the night before: yes, there it is! Whey solids! Into the trash can it goes -- time for a good water fast to cleanse the toxins...right after the high colonic irrigation... And when they start to eat again, it will be better -- no seeds, tomatoes, or greens...No, this time they'll do it right. Soon, guilt and shame accrue to almost everything that is eaten. "Output" is scryed as to content, consistency, and amount, and can become an obsession in its own right.

When the disorder is in its most advanced stages, the sufferer cannot even eat in front of another person, much less socially, and generally punishes themselves for the food they do eat: I roomed with a bicycle racer who only ate organic potato chips, sprayed with tomato powder, consumed in the bathroom from the toilet lid. It also becomes the case that diet does become more and more a factor in the health problems that increasingly plague them: I also remember going to a vegan event, listening to a man with sunken eyes and pipestem legs tell me that his life had gotten much better now that he cut out protein. "You should have seen me before." (The cyclist I alluded to before had bleeding gums, as well.) Such health problems are often ascribed to a "crisis of health", whereby the body is simply "resetting itself", or "learning to transform nutrients": soon everything will be just fine.

The prognosis for many such people is bleak: few of them will listen to doctors and since diet becomes their identity, it is hard to treat. One only hopes that with recognition of this disorder, help will become more readily available.