The ‘clean eating’ movement is ‘ugly, malevolent and damaging’

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CleanEatingAt best, the “clean eating” fad is nonsense dressed up as health advice, writes a British eating disorder expert Dr Max Pemberton in an open letter to the Daily Mail. “At worst, it is embraced by those with underlying psychological difficulties and used to justify an increasingly restrictive diet — with potentially life-threatening results.”

Pemberton writes: “Before she’s even opened her mouth, I know what the young woman sitting in front of me is going to say. She wears a big, baggy jumper to hide how underweight she is. Her face is so sunken that she looks more like a cadaver than a human being. When I ask her to take off her layers so that I can weigh her, I am taken aback at the sight of every vertebra sticking out of her back.

“She is 20, in her second year of university, with her whole life ahead of her. So why, at a time that should be full of promise, optimism and excitement, am I staring into the desperate face of another lost soul? The reason? She has one over-riding concern, one thing that dominates her thinking and drives virtually every choice she makes: ‘clean eating’.

“For those of us who work in treating eating disorders, ‘clean eating’ – a trend that focuses on avoiding processed foods and consuming raw, unrefined produce – is a phrase we have come to dread.

“This woman has been referred to me because, concerned about her weight loss and obsession with healthy eating, the counsellor she was seeing at university has insisted that she speak to her GP, who, in turn, referred her for specialist assessment.

“The GP referral letter was like nearly every one we receive these days. The young woman started to become interested in eating healthily, cut out processed foods, became worried about the sugar content of food, now eats mainly just vegetables and so on.

“By the time she gets to see a specialist such as me, she is often emaciated. Her collarbones jut out at angles, her legs are so painfully thin that, sometimes, she is unable to even squat down, or walk up a flight of stairs because her body is so desperate for an energy source, it has started effectively eating its own muscles.

“Occasionally, I will see a woman whose body is struggling so much to bear her remaining weight that it has started to consume the muscles in the neck that keep the head up, meaning she can’t lift her head. I’ve had to admit several such patients as an emergency straight from my clinic because, otherwise, they will soon die.

“Many of them will no longer have periods – their reproductive system shuts down because their body would be unable to feed a foetus. They develop osteoporosis (thinning of the bones) and this can lead to fractures.

“Of course, not all are so emaciated. Some just exist in a state of low-level malnutrition. Their skin is dry and flaky because of the lack of proper fat in their diet and their hair is falling out. Many are depressed. They complain of being tired all the time, perishingly cold, and struggle to concentrate because the brain, which needs a steady supply of glucose to function properly, has been deprived for some time.

“Sometimes, their body is so desperate for nutrition – especially carbohydrates – that it will trigger a binge on high-calorie, sugary foods as a last-ditch attempt to keep the brain going. They will then be racked with guilt and shame because they have broken their ‘clean eating’ diet and so will make themselves sick, sometimes many times.

“In these cases, trauma to the throat can cause severe bleeding and damage to the teeth. Many of my patients have now lost teeth, and several of the really unfortunate ones have dentures. Most worryingly, though, repeated vomiting means the body can lose vital electrolytes, chemicals that have a range of functions from regulating heartbeat to enabling our bodies to move. When these are knocked out of balance, it can result in heart attack.”

Pemberton writes: “At best, clean eating is nonsense dressed up as health advice. At worst, it is embraced by those with underlying psychological difficulties and used to justify an increasingly restrictive diet – with potentially life-threatening results.

“Of course, this is a well-worn track. Every few years, doctors like me notice a trend that grips the public as the answer to obesity. Celebrities jump on the bandwagon, bestselling books are written.

“Ella Woodward, who extolled the virtues of ‘clean eating’ before distancing herself from the movement, sold 300,000 copies of her book Deliciously Ella. She has since said early this year: ‘When I started my blog, I used the term “clean eating” which I took to mean natural and unprocessed foods. ‘As the term has continued to be used, I have distanced myself from it as I felt the meaning has changed and has been overused to package negative fads, which I do not support.’ She added: ‘I am removing the word “clean” from posts to ensure no relation to the new meaning of the word and what it has come to represent.’

“The Hemsley sisters, Jasmine and Melissa, who wrote The Art of Eating Well despite holding no formal qualifications in diet, nutrition or cookery, were given their own Channel 4 show.

“While not directly responsible for encouraging eating disorders, they epitomised the modern trend for charismatic gurus to play on their looks and life stories to influence their audience and make them buy into their food philosophy.

“Yet, while they might appear to differ, these diets that come and go always contain the same fundamental facets – they demonise entire food groups with the promise of health, vitality and weight loss. They are the modern-day religion, an answer to our prayers. Then, eventually, they fail to deliver – because any diet based on denying entire food groups will always fail – and the whole circus moves on to the next fad.”

But, writes Pemberton, the clean eating fad is particularly pernicious because it hides behind the notion of ‘healthy eating’. “Yet, as every dietitian will tell you, sensible eating is about balance in your diet, not exclusion. This obsession with ‘healthy’ eating is termed ‘orthorexia’ – which literally means a ‘fixation on righteous eating’.

“Long before ‘clean eating’ came on the scene, doctors like me would see some patients with eating disorders who would describe an obsession with trying to eat healthily. The difference now is that the whole clean eating movement gives them a veneer of respectability. This means they can easily justify their behaviour not just to themselves, but also their families. As a result, patients seek help much later, often only when their health has significantly deteriorated and their weight has become dangerously low.

“Orthorexia has long been established as a disordered, unhealthy way of thinking, yet medically, it is indistinguishable from clean eating. Every person I see in my eating disorder clinic is ‘clean eating’. As a result, patients seek help much later, often only when their health has significantly deteriorated and their weight has become dangerously low.

“A few months ago, at a dinner party, I sat next to a bright, funny 16-year-old. She was full of life. When I told her I worked in eating disorders, she pulled out her phone and showed me the images she was bombarded with on a daily basis on Instagram. Emaciated women posing on the beach, clavicles jutting out at angles, hips protruding. Not just one or two images, but thousands upon thousands.

“‘It’s not normal to look like that, is it?’ she asked. ‘No,’ I said. ‘None of this is normal.’ Of course, there will be people who say that they follow ‘clean eating’ and don’t have an eating disorder. They will say that they are healthy, that it’s modern food which is bad and they have eradicated this from their lives.

“Rubbish. The central tenet, the very nugget at the core of its belief system, is flawed. The very notion of ‘clean’ eating suggests that some food is dirty or bad – and this simply isn’t the case.”

Pemberton writes: “It’s an inherently disordered way of viewing the world. There are healthy and unhealthy quantities of different types of food, but food in itself is just food.
Particularly worrying is that many of those promoting it have no training in nutrition and are not dietitians.

“Even among those who do, scratch beneath the surface and you find many have qualifications from discredited institutions peddling absolute quackery and yet their advice, guidance and recommendations are given weight and credence.”

And, he writes, of course, it’s turned into a vast commercial enterprise, with many of the so-called ‘gurus’ who are promoting this fad making vast sums from cookbooks or endorsing products.

He writes: “If they were doctors or dietitians promoting non-evidence-based practice and promoting such unhealthy ideas about food, they’d have their licence to practice revoked and be struck off. Yet, as there’s no way of regulating this area, they go uncensored.

“The central dilemma here is that the proper, sensible way to eat is everything in moderation. I’m aware that this is a tired, boring answer. But it’s true. This is the way that people have a normal, healthy relationship with food. This is how people avoid yo-yo dieting or guilt and shame associated with eating.

“Of course, this doesn’t sell books or gain you thousands of followers on social media.
We like the idea that somewhere out there is an answer, and the more prescriptive and restrictive it is, the more we can convince ourselves that this must be it.

“Humans far prefer drama, and this is why the endless cycle of excess and restriction, sin and absolution, is so appealing. But be under no illusion: ‘clean eating’ is ugly, malevolent and damaging. The whole irony of the clean eating fad is that, despite what it purports to be, it’s fundamentally toxic.”

Daily Mail report

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