A common trait shared by most endurance athletes is a determination to succeed in the goals that we set ourselves. We are focused and committed in our approach to improving our performance in our chosen sport: undertaking a demanding training programme, paying attention to recovery and doing our best to make lifestyle decisions which support both our athletic goals and our health and wellbeing. Part of this approach, of course, involves following a healthy diet, one which provides sufficient energy for training and racing, is suitably balanced between carbohydrates, fats and protein, meets requirements for vitamins and minerals, and optimises body composition.
My work as a nutritionist supporting endurance athletes means that I usually see clients who are very motivated to improve their diets as part of their quest for better performance. My approach is to develop a well-balanced eating plan for them, as I have described above, tailored to their specific goals and considering their food preferences, cooking ability, time available to make meals and any health issues, such as digestive problems, injuries or diagnosed medical conditions.
Sometimes, however, I will see a client who feels that they are following ‘healthy eating’ habits but are not seeing the positive impact on their health and performance which they expect. The diets followed by these clients are often low in processed foods, refined carbohydrates and added sugars while primarily focused on vegetables, healthy fats, fruit and lean protein. So far, so healthy…..But commonly, I find they are also excluding gluten or dairy unnecessarily, have become vegan, are minimising carbohydrates, or are following a ‘low carb high fat’ or ‘paleo’ approach. With care, it is possible to perform well on such dietary approaches, but they can also potentially lead to inadequate energy intake and/or nutrient deficiency, particularly if two different approaches are combined and too many food groups excluded. This can be the case if an athlete is aiming to “eat clean”.
Such a client might be low in energy, struggling to undertake training sessions successfully or recover well from them, experiencing recurrent injury or have signs of hormone imbalances such as a lack of menstrual periods, low testosterone or thyroid dysregulation. They might have had a nutrient deficiency such as iron, calcium, vitamin D or vitamin B12 identified in a blood test. Such signs may all form part of a condition known as Relative Energy Deficiency in Sport (or RED-S for short). See my blog here for more on this.
I have found that the best way forward with these clients is to help them increase their energy intake, particularly their consumption of carbohydrate foods, and persuade them to add unnecessarily excluded foods back into their diet. It is perfectly possible to be a healthy endurance athlete if you need to be gluten free or dairy free, but such foods should not be excluded without good reason, i.e. consuming the food causes a clearly identified digestive problem. Equally, while consuming too much sugar is associated with weight gain and subsequent poor health outcomes, there are times – hard training sessions, racing, urgent refuelling – when sugar is the endurance athlete’s friend! It need not be avoided completely. If a client wishes to follow a vegan diet, I will work with them to ensure that this is optimally balanced for good health: see my blog post here for more on how to do this. Whether a low carb high fat or paleo dietary approach benefits performance or health is the subject of much debate, but it may suit some athletes (and often helps with weight loss). But if a client is experiencing adverse health or performance issues on such a diet, I will encourage them to make some changes.
As I have explained, it is possible to resolve health and energy issues, and consequently improve performance if the athlete is open to making changes and, often, eating more food. But there are some people who find this very difficult and become obsessed with ‘healthy eating’ to the extent that adhering to the dietary rules that they have set themselves control their way of life or become fundamental to feeling good about themselves. Although not yet a medically recognised eating disorder, this behaviour is known as ‘orthorexia’, an obsession with correct eating. The term was first coined in 1996 by Dr Stephen Bratman. Orthorexia isn’t the same as following a specific way of eating, however extreme that may be, but occurs when being enthusiastic about healthy eating or following a specific diet tips over into obsession, involving emotional factors and becoming psychologically unhealthy.
Orthorexia is the subject of an excellent new book1 by registered dietician Renee McGregor, who specialises in both sports nutrition and eating disorders. Reading this book made me think about how some endurance athletes, who are perhaps obsessed with improving their performance, may be prone to developing orthorexia and I want to use this blog post to help you to recognise if you might be at risk. Equally you might have a friend, family member or club mate who is showing signs of orthorexia. These include:
- Unrealistic expectations of the benefits of certain foods and diets
- Elimination of whole food groups, aiming for a ‘clean’ diet rather than for necessary medical reasons
- Excessive expenditure on food, with an obsessive focus on its quality
- Compulsive behaviour around food, such as precise weighing of ingredients
- Feelings of superiority about a personal way of eating
- Reluctance to eat food made by others, such as turning down social events that involve eating
- Guilt over breaking self-imposed food rules and a need to compensate for this through food restriction or extra exercise
- Pursuit of an idealised self-image
- Losing interest in other activities while feeling fulfilled from eating ‘healthily’
- Distancing self from friends or family who do not share similar views about food
Perfectionism and anxiety are also linked with the development of orthorexia, and exercise can become as much as an obsession as food. Signs of the latter to look out for are missing important appointments, social events or family commitments to undertake a training session, refusing to be flexible about a training plan or exercising through pain. You might only identify with a couple of the orthorexia signs that I have listed above, but it’s important to catch any changes in your behaviour early. An obsession with healthy eating tends to get worse over time, with more and more foods excluded from a person’s diet as they seek ‘purity’, with its perceived benefits for their health and wellbeing – and performance in the case of endurance athletes.
If you are concerned about yourself or someone close to you, I recommend that you read Renee McGregor’s book, which is called Orthorexia: When Healthy Eating Goes Bad, which you can buy here. I also recommend that any endurance athlete takes a look at one of her Fast Fuel books for recipe inspiration and well balanced nutrition advice: see here.
There is also a short questionnaire on Dr Bratman’s website which may be useful to help identify if you are at risk of orthorexia. Click here to access it.
If you are experiencing orthorexia, it is important to seek both nutritional and psychological help. Look for a nutrition professional with experience in supporting people with eating disorders, such as from the UK dietician’s register. Please be aware that I am not trained to work in this specialist area myself. For counselling or Psychotherapy in the UK, look at the BACP Register of Counsellors and Psychotherapists. The charity BEAT also has some useful resources.
Jo Scott-Dalgleish BSc (Hons) is a BANT Registered Nutritionist, writing and giving talks about nutrition for endurance sport. Based in London, she also works as a Registered Nutritional Therapist, conducting one–to–one consultations with triathletes, distance runners and cyclists to help them eat well, be healthy and perform better through the creation of an individual nutritional plan. To learn more about these consultations, please visit www.nutritionforendurancesports.co.uk
1 Renee McGregor RD SENr. Orthorexia: When Healthy Eating Goes Bad. Nourish Books (2017).