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In a vegan cafe in New York City, Nisha Moodley pushes a glass crusted with the remnants of a berry-acai-almond milk smoothie across the table and begins listing the foods she excised from her diet six years ago.

"Factory-farmed meats; hormone-laden dairy; conventional nonorganic fruits and vegetables; anything hydrogenated; anything microwaved," the slender 32-year-old health coach says. "I would not eat irradiated food; charred or blackened foods; artificial coloring, flavoring, or sweetener; MSG; white rice; sugar; table salt; or anything canned."

Back then, a typical breakfast for Moodley consisted of buckwheat mixed with seaweed, raw cacao powder, flax oil, and flax seeds. Lunch was usually homemade brown rice with lentils, fresh vegetables, and kale, followed by a midafternoon snack of homemade flax-seed-and-buckwheat crackers. And for dinner, a salad with garbanzo beans, avocado, carrots, beets, and mushrooms.

Moodley initially adopted this diet to address recurring bad digestion. But her commitment to healthy eating—something to be commended, ordinarily—turned into an obsession that took over her life. "I was terrified of food that didn't fit within my idea of what was healthy," Moodley says. "I was terrified of cancer, of dying."

She couldn't eat out with friends, attend dinner parties, or shop at certain grocery stores because of her intense phobia. Her anxiety was so overwhelming that her stomach problems worsened.

Moodley knew she had a problem, but she didn't view it as an eating disorder. Although she had been a self-described "emotional overeater" for most of her life, the naturally slim Moodley had never been concerned about her weight, nor had she ever purged after her binges. Her unhealthy fixation with healthy food was something else, and it was years before she realized it had a name: orthorexia.

Orthorexia is not an official diagnosis. The American Psychiatric Association (APA) does not recognize it, and some eating-disorder clinics aren't even aware of it. But orthorexia—which seems to include elements of other disorders, such as anorexia and obsessive-compulsive disorder—can be a serious problem. Left untreated, experts say, it can lead to malnourishment, anorexia, or disabling anxiety.

Next Page: A murky diagnosis A murky diagnosis
Steven Bratman, MD, coined the term orthorexia in a 1997 essay for Yoga Journal in which he described the disorder as a "fixation on eating proper food." Bratman, who himself had a food fixation while living on a commune in upstate New York, chose the prefix "ortho"—which in Greek means straight, correct, true—to reflect the obsession with maintaining a perfect diet. Dr. Bratman described orthorexia in greater detail in the 2001 book Health Food Junkies, but it remains largely unrecognized and poorly understood.

It doesn't help that people with orthorexia can get positive feedback for behavior that appears healthy. For many people, strict diets such as veganism, locavorism, and fruitarianism (exactly what it sounds like) have become a way to eat healthier and also address their concerns about how food ends up on our tables.

"One of the things that's tricky about our culture is that orthorexia is socially acceptable and often even heralded as a great statement of self-control and doing the right thing for your health," says Amanda Mellowspring, a registered dietician in Miami who specializes in eating disorders.

The key difference between orthorexia and simply following a strict diet, Mellowspring says, is that orthorexia causes distress and interferes with everyday life. "What it boils down to is, how much does it negatively affect their life?" she says. "How much does it affect their social life? How much time do they spend thinking about food?"

Although orthorexia shares characteristics with anorexia, orthorexics don't always lose weight since they fixate on the quality (as opposed to quantity) of food. And they usually lack the distorted, negative self-image—known as body dysmorphia—that causes some anorexics to look in the mirror and see oodles of fat when in fact they're severely underweight. "Body dysmorphia will make you miserable, and those with orthorexia tend not to have that," says Alan Kaufman, a licensed clinical social worker who works with patients with eating disorders at Alta Bates Summit Medical Center, in Berkeley, Calif.

That's not to say orthorexia doesn't pose health risks. Some patients do become malnourished and dangerously underweight, and dietitians and therapists say orthorexia can become a gateway to anorexia or bulimia.

In fact, orthorexia may in some cases serve to disguise anorexia. Because it's more socially acceptable to say, "I want to be healthy," than to say, "I want to fit into these skinny jeans," some anorexics may use orthorexia as a cover for their behavior. "[This is a] very common hidden agenda behind orthorexia," Dr. Bratman writes in Health Food Junkies. "A dietary theory can allow women to seek the culturally accepted norms of beauty without admitting it to themselves. … You can 'accidentally' live up to the Barbie image without admitting you believe in doing so."

Similarly, recovering anorexics or bulimics sometimes latch on to orthorexia. Elizabeth Dear, a therapist based in Reno, Nev., who works with eating-disorder patients, says she does not consider anorexics fully recovered if they judge themselves according to the quality of the foods they eat. "This so-called healthy eating can easily develop into eating-disorder thinking," she says.

Next Page: How orthorexia starts How orthorexia starts
Orthorexic tendencies often begin as a result of health problems. Alena's obsession with healthy eating started in 12th grade, when she found out she had Candida (a type of yeast infection) and a homeopathic doctor asked her to stop eating yeast, wheat, sugar, and dairy for several weeks as part of her treatment. She was already a vegetarian, so she mainly ate rice and vegetables. (Alena did not want her last name published.) Then, when she was 19, she went to a naturopathic doctor with a collection of stomach symptoms, including nausea, constipation, and indigestion, and was again instructed to avoid processed grains, sugar, soy, dairy, and nuts. "And that's when I went crazy," says Alena, now a 22-year-old student at NYU. "I basically cut out everything from my diet. I convinced my mind that food made me sick."

Alena still goes through bouts where she swears off those food groups, and her forbidden list now includes carbohydrates, beans, tropical fruit, sugar, farmed fish, and potatoes that aren't from her own garden. Meat, nonlocal produce (such as bananas), juice, beer, and dairy are all "evil," she says. "What I do eat are a lot of vegetables. I have to have vegetables in every meal or I feel sick," she says. "I eat whole grains like barley, whole-grain kasha. Not rice, because it really hurts my stomach and for political reasons, because it is shipped from too far away. I eat seasonal fruits, fish, and eggs."

For Alena—who has never been to a therapist or nutritionist to discuss her behavior—anorexia and orthorexia go hand in hand. She has experienced bouts of body dysmorphia and sometimes exercises excessively to make up for minor eating binges, such as overindulging on dessert. She also exhibits other traits common among those with eating disorders, such as living vicariously through the diets of others. She often bakes for her family and roommates, and urges her sister to order hamburgers at restaurants so she can watch her enjoy them.

"The distinction for me is, anorexia is about what I look like and orthorexia is about my lifestyle," Alena says. "I want to feel good about what I'm eating. I want to feel cleansed and detoxified. And at times it is related to image. But I worry that if I start eating in an unhealthy way I'm going to start having stomach issues."

It may not be a coincidence that Alena studies food and agricultural policy in school. Few studies have been done on orthorexia, but some researchers have speculated that restrictive diets and orthorexic tendencies may be more common in dietitians and nutrition students.

Moodley's interest in nutrition and career choice certainly influenced her diet. Her burgeoning orthorexia seemed to worsen when she began studying at a nutrition school in New York City. (She stopped eating frozen vegetables, for instance, when she was taught that plant cell walls expand and break down from low temperatures, sometimes resulting in lost nutrients.) "If I had to draw a line, I'd say that my interest in nutrition spurred orthorexia," she says.

Next Page: How to get help How to get help
Therapists, nutritionists, and eating-disorder experts have slowly begun to take orthorexia more seriously. Anorexia and bulimia were similarly slow to be recognized: Anorexia was long considered a symptom of hysteria, while bulimia was regarded as a type of anorexia and was not considered a disease in its own right until 1980.

There are no plans to add orthorexia to the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM), a new edition of which is scheduled to be released in 2013, in part because of the dearth of research. "The problem is, we don't know enough about it," says B. Timothy Walsh, MD, a psychiatrist at Columbia University, in New York City, who chairs the Eating Disorders Workgroup for the new edition. The workgroup does, however, recommend adding to the DSM something called Avoidant/Restrictive Food Intake Disorder, which pertains mainly to children and preteens who are excessively picky eaters, to the point that they become undernourished.

Dear, who has been working with patients with eating disorders for 11 years, says adding orthorexia to the DSM could benefit people with the disorder by making clinicians more likely to recognize it. She says inclusion in the DSM could also be "counterproductive," however, if the diagnostic criteria are too narrow and leave some cases undetected and untreated.

If you suspect that you or someone you know may be orthorexic, Kaufman suggests approaching with care. "When you have a full-blown eating disorder there is a strong degree of denial [about] the extent of the condition," he says.

Recognizing orthorexia can be difficult if a person does not yet show outward signs of malnutrition, Kaufman says, but if the disorder has become medically compromising then they may need treatment to help them change their eating patterns and their thoughts that go along with eating. (Directories of eating-disorder experts can be found on the website of the International Association of Eating Disorder Professionals.)

The ultimate recovery from an eating disorder is to get beyond labeling foods good or bad, Dear says. "You have to reach a self-loving place, not a virtuous place. It would be helpful [for] clinicians to have their radar out for orthorexia because it is easily misread as just healthy eating when it can be a major problem."

Moodley no longer considers herself orthorexic. Her work with clients made her realize that the correct diet is different for each individual and helped her overcome her orthorexia. But when she discusses her diet today, a sense of pride still lingers in her voice. To some, her diet was the epitome of healthy perfection. She said she still maintains a healthy diet, but now it is a preference as opposed to an obsession. She prefers fresh vegetables, but isn't opposed to eating them frozen and she doesn't think of all sweets as junk anymore. She says her fears of "bad" food are gone.

But it still takes Moodley several moments of silent reflection before she can recall the latest treat she ate. Finally, after some deep thought on the matter, she remembers: "Two days ago. I had a cookie. An organic cookie."

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One morning when I was in my 20s, I woke up to the familiar sound of a banging radiator and the unfamiliar sensation of spinning. A half beat after I opened my eyes, I felt a strong swell of nausea. To my single 25-year-old mind, this was the stuff of nightmares. I dragged myself to a drugstore and bought a pregnancy test. Negative. So I resigned myself to waiting it out.

It proved to be a long wait.

Weeks later, I developed abdominal pain. Next, a urinary tract infection that had no regard for antibiotics. My doctor ran tests, looking for red flags—an elevated white blood cell count, a thyroid hormone out of whack, something. But they were all normal. Stumped, he referred me to specialists: a urologist, a gynecologist, a gastroenterologist. I had an endoscopy, a barium X-ray, a colonoscopy. And the theories flew: ulcers, endometriosis, lupus. They kept me up late at night, wondering if the most recent theory would be the diagnostic version of Mr. Right—but without the joy that implies. I just wanted an explanation.

My doctors prescribed even without a diagnosis. I took a drug to speed gastric emptying, prescription antacids, even a drug that put me in faux menopause. Nothing worked. And the side effects were awful. I had hot flashes. My stomach was raw from antibiotics.

My father, an oncologist with a policy of not treating his family, watched anxiously from the sidelines. "Stop seeing specialists," he advised. "They only think about their 10 inches of the body." So I stopped seeing doctors. I still had my symptoms, but I made sure I was always near a bathroom. In that way, I achieved semi-normalcy.

Then one day, five years after that first wave of nausea, sitting in a pizzeria sipping water and eating soup, the smell of pizza hit me full force. I wondered what it would be like to eat without feeling sick. A wave of anger and determination hit me. It was time to resume the search for a diagnosis.

I thought hard about what I wanted in my next doctor the way some people envision their ideal spouse. I wanted to find an internist, someone who looks at the bigger picture. I found one who had studied acupuncture in China; he spent an hour asking me questions. One was whether I’d traveled before I got sick, something other doctors had asked me, and to which I’d always answered no. It’s a flow chart–like question meant to address the issue of parasites. If you haven’t traveled, they check negative and move toward another explanation. "You know," he said, "I think we ought to test for parasites, anyway." With the way people travel these days, he said, they can bring parasites to us.

One week, a blood test, and a stool sample later, I had an answer: Entamoeba histolytica, a parasite common in undeveloped countries with contaminated water. It can be transmitted by an infected person who has skipped washing his hands after going to the bathroom, then handled your food. Two weeks of the right antibiotics and the symptoms were gone.
Now, like someone who’s made a bad choice in spouses on the first go-round, I am exceedingly careful about whose hands I put myself in. I can’t fix a medical system reliant on tests. But I can pick doctors who listen, ones who actually think—and not just test—their way to an explanation.

The Controversy
In September, The Dr. Oz Show reported that apple juice sold in the U.S. may contain levels of arsenic that are dangerous to our long-term health. The U.S. Food and Drug Administration (FDA) shot back, saying that apple juice is safe and that Dr. Oz’s claims were "irresponsible." Who’s right—and should we be worried?

What the Experts Say
First, some background: Arsenic is an element that occurs naturally in the environment. It once was in pesticides in the U.S., and is still used in them in some other countries. The Environmental Protection Agency and the FDA monitor arsenic in drinking water and food, making sure levels are low enough to not be a concern when it comes to the risks of long-term exposure, which include cancer and neurological problems. But while the FDA has set limits on levels of arsenic in certain products, it hasn’t set a standard for juice.

The Dr. Oz Show had an independent lab analyze 36 samples of five store-bought apple juice brands. Ten of them showed concentrations of arsenic higher than the amount allowed in drinking water. (The juice companies involved dispute these results.) In response, the FDA explained that its own tests for the same juice brands found much lower levels of arsenic. But The Dr. Oz Show isn’t the first to raise this alarm: A 2009 study from the University of Arizona and a 2010 report by Florida’s St. Petersburg Times had similar findings. One possible explanation: Most apples used to make American juice are actually grown outside the U.S., in countries such as China, where arsenic may still be used in pesticides, Dr. Oz says.

"I do think arsenic in juice is a hazard," says Chensheng Alex Lu, PhD, associate professor of environmental exposure biology at the Harvard School of Public Health (who is unaffiliated with The Dr. Oz Show). "No one can guarantee that if you were to drink a juice a day for years that it wouldn’t cause adverse health effects down the road." Young children are especially susceptible to the effects of toxins like arsenic, Lu adds. "We just want to err on the side of caution," Dr. Oz told Health.

The Bottom Line
Arsenic in apple juice poses no immediate health threat, but no one knows how safe it is in the long run. If you or your kids drink a lot of juice, consider doing what the Oz family does: Opt for organic juice made with apples grown in the U.S., which Dr. Oz says may contain lower levels of arsenic. (Note: At press time, Dr. Oz told Health he was planning a follow-up show to explore this issue further.)