You can’t walk past the magazines in the supermarket, go out to dinner with friends or check your Instagram feed or Facebook these days without being bombarded by diets aimed to cure whatever ails you. All these plans—whether they’re gluten-free, Paleo, organic, vegetarian, or vegan—involve eliminating foods purported to cause a host of health problems.
One such popular program goes so far as to promise it will “change your life in 30 days,” offering testimonials (which, I might point out, do not count as scientific evidence) from participants who claim it has cured them of a long list of so-called “lifestyle-related diseases.” These include but are not limited to: high blood pressure and high cholesterol, diabetes (both Type 1 and Type 2), asthma, allergies, infertility, depression, bipolar disorder, arthritis, ADHD, and inflammatory bowel disease. The psychiatric literature, last I heard, doesn’t consider depression, bipolar disorder, or ADHD lifestyle-related diseases. That’s a topic for another post. But for now, I’ll get back to the subject at hand.
Even the widespread trend towards “clean eating”—whose proponents like to think of it not as a diet, but as a lifestyle choice or even a movement—comes with rules. Eat lots of fruits and vegetables. Eat only “whole” meats, preferably organic, whose sources you know. Eat only whole grains. Avoid all processed and refined foods (e.g., sugar, baked goods, white flour, white rice, empty-caloric junk foods). Avoid saturated and trans-fats. Drink at least 8 cups of water a day.
“What’s wrong with trying to follow a healthy eating plan?” you might ask. And my answer would be, “Nothing. Usually.”
But if you tend to become fixated on avoiding specific foods because you’re excessively concerned about controlling your weight or think they might cause cancer or other diseases, be careful. Even a so-called “non-diet” like the clean-eating approach can lead to emotional struggles for perfectionistic people prone to eating disorders or health anxiety.
Any time perfectionists impose all-or-nothing restrictions on themselves, they run the risk of getting upset and ditching the diet altogether if they think they’ve broken the rules. It doesn’t even have to constitute a major transgression, such as picking up a Big Mac, fries, and large Coke from the MacDonald’s drive-through on the way home from work. If you’re evaluating your food choices from the perspective of a black-and-white mentality (and comparing them with the colorful Instagram images of the kale smoothies, grain bowls, and lush farmers market produce others appear to be eating), you could easily beat yourself up for popping a handful of M&Ms at the movies or having white rice with your homemade, clean Pad Thai. Then you might decide you’ve blown it for the day (or week), and let loose with a full-blown binge. You’ll feel guilty, vow to atone and never stray again, and set yourself up for the next self-punishing cycle of deprivation and excess.
Let me make my position clear before the critics jump on me for questioning sound nutritional practices. I’m not suggesting you go overboard with the junk food and the trans-fats. I’m not urging you to forego whole grains in favor of Wonder Bread. I’m not recommending you trade your bottled water for a Big Gulp. I’m not even telling you the clean-eating lifestyle is bad. (Though I might be telling you not to drink the diet Kool-Aid du jour without seriously evaluating its claims from an evidence-based perspective).
But when food—no matter how nutritionally pure, unadulterated, and good for your body it may be—becomes a source of internal conflict, guilt and anxiety, you might want to think about what it’s doing to your mind.
As with most things in life, moderation and flexibility are the keys to emotional wellbeing. Your mindset about eating is just as important for your health as the foods you eat. Sadly, Instagram can’t capture that.
If you’re prone to anxiety, you know how shaky it can make you feel—not just physically (that’s why it’s called “the jitters”) but also emotionally. When you’re stuck in a cycle of worrying, you start to question everything.
One common way to respond to doubt is by looking for reassurance. A person with Obsessive Compulsive Disorder (OCD), for instance, may lock the door and then return again and again to check it, or jiggle the knob five, ten, or twenty times to make sure it’s secure. Or she may leave but mentally reenact her departure on her way to work to convince herself she turned the key and heard the latch click.
In the case of repetitive door-checking or any other ritual involving actions you can observe, it’s easy to see how seeking reassurance can become a disruptive compulsion. But other forms of compulsive reassurance-seeking are less obvious, though no less problematic.
Many reassurance rituals take place internally, as with the OCD-sufferer who tries to picture locking the door after she’s left the house. Mental compulsions also occur frequently with the so-called “repugnant” obsessions—fears of being a pedophile or a murderer, say. While such obsessions are an extremely common manifestation of OCD, people who experience them usually feel intensely ashamed and will go to great lengths to keep them hidden.
Incessant questioning is another typical reassurance ritual aimed at minimizing anxiety about uncertainty. It might take the form of constantly polling friends for their opinions about a romantic partner or repeatedly asking a colleague if the boss seemed annoyed when you were five minutes late for the staff meeting. The key words here are “constantly” and “repeatedly.” Asking for others’ opinions and feedback isn’t necessarily an unhealthy practice. But when the need for reassurance is driven by anxiety, getting someone else’s take on a situation is never enough to quell the doubt and the feelings of dread accompanying it.
In our age of infinite information access, it’s especially easy to indulge the urge to question. Have your friends gotten sick of telling you they think your girlfriend is cool? No problem. Just google “How do I know if my partner is right for me?” and you’ll find countless answers*.
[Caution: Don’t read this if you’re prone to relationship anxiety.] *My own search turned up, just for starters: 31 Ways to Know You’re In the Right Relationship, 10 Ways to Know if the Relationship is “Right,” Courage to Know When a Relationship is Not Right for You, Should I Break Up with My Boyfriend Quiz, How to Determine if You’ve Found Your Soulmate, and I’m Not Sure If I Want to Break Up with My Boyfriend.
For people with health anxiety, looking for reassurance online can be a particularly compelling ritual. Worrying about that suspicious lump? Ask WebMd! There are even sites where you can send photos of whatever ails you to be evaluated by a real doctor. (But, to be clear, I’m not recommending it.)
It’s easy to fool yourself into thinking you’re only being thorough if you’re in the habit of doing endless research before making a major life decision or even just a minor purchase. But anxiety about a wrong choice is often the driving force behind such indecisiveness. For those perfectionistic types, selecting a course of graduate study might involve looking into countless degree programs; taking the GRE, LSAT, and GMAT to cover all the bases; comparing employment statistics for different careers; going on dozens of informational interviews; and asking friends and family for their recommendations and advice.
If you feel you need to know all the options before making a decision, even a low-risk commitment like buying a pair of rain boots might set off the process of exhaustive research and advice-seeking.
I can relate. Even though I usually can decide with only a little hesitation about where to stay on vacations and which kitchen appliances to buy, I’m less confident when it comes to interior decoration. I confess to having recently wasted an entire afternoon searching for an end table after having uncovered the “25 Best” online design sites and looking at all of them. And I still haven’t ordered any furniture.
Seeking reassurance, whether through compulsive checking, mental reviewing, or information gathering clearly can get in the way of decisive action. So how do you know if it’s a problem for you or just an occasional annoyance? I’ll explain in my next post.
In my clinical practice, I specialize in treating Obsessive Compulsive Disorder and the so-called OC spectrum disorders. One of the most common is health anxiety, which is better known by the older and more negatively loaded term, “hypochondriasis.” Whatever you call it, this excessive worry about illness can overtake the lives of those who have it.
I can’t say for sure if the prevalence of health anxiety has increased in the last decade, but judging from my admittedly unscientific personal experience and a cursory scan of the data, it seems to be on the rise. In the days before the Internet, a person with health worries might have read the Merck manual to assess symptoms or gone to the doctor for reassurance. Now we’re all diagnosticians, taking cell phone photos of troublesome moles to compare with online examples of cancerous lesions, typing symptoms into WebMD, and using Internet forums to share stories about medical mishaps and exotic illnesses. But without the depth and breadth of information and the context for interpreting it that comes with medical training, it’s easy to misinterpret physical sensations and overestimate the seriousness of a problem or the likelihood of its occurrence.
I thought about this as I read a story in Sunday’s New York Times Magazine about how General Mills has jumped on the gluten-free bandwagon, using the latest health fad to kick start a marketing campaign for their GlutenFreely line of products. Celiac disease, the inability to digest the gluten found in wheat and several other grains, is a serious, even life-threatening, illness. It is five times more common today than it was fifty years ago, and an estimated 18 million Americans suffer from some degree of gluten sensitivity, if not full-blown celiac disease. But the explosion of gluten-free options on supermarket shelves and restaurant menus makes it seem even more prevalent.
For those with a true gluten sensitivity, this is a welcome trend. But for those prone to health anxiety, it’s just one more trigger for unnecessary worry. As the Times article points out, athletes have embraced the gluten-free diet, claiming it gives them more energy and enhances performance. So have several celebrities, including Gwyneth Paltrow, who touts it as a weight-loss method and Jenny McCarthy, who believes it cured her son’s autism. No matter that scientists dismiss such claims because there’s no research backing them. If you’re overly attuned to your body, as people with health anxiety are, you’re likely to focus on every physical sensation and are highly suggestible. And if you buy into the celebrity endorsements—and a lot more people follow Us Weekly than the New England Journal of Medicine—going gluten-free will seem like a panacea for whatever ails you.
I’m a little embarrassed to admit to my own brief, three-day experiment with the gluten-free lifestyle. Drawn in by the promise of clear-headedness and boundless energy, I decided to test it out for myself. I replaced sandwiches with salads at lunch and pasta with potatoes at dinner. And for breakfast, I tried a great recipe I found in Bon Appetit for the Garmin cycling team’s gluten-free pancakes. My husband and I both agreed we felt less weighed down and more energized than we do after eating our usual whole wheat variety.
There was only one problem. The Garmin pancakes weren’t gluten-free. They contained spelt flour, which is a wheat product, and oat flour, which gluten-free purists eschew.
As it turned out, the regimen wasn’t for me. It made me feel deprived, which caused me to overindulge in too many inferior wheat substitutes, like peanut butter cookies made with teff flour. I’m back to eating pizza and muffins, and I feel much more satisfied, albeit a little more sluggish. But maybe that’s the result of Thanksgiving, not gluten.
Without a compelling medical reason to go gluten-free, proponents of this newest dietary trend may be showing symptoms of a sensitivity not to wheat, but to health concerns. And for that, I’d say a gluten-free diet would be contraindicated.
This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.