Can Your Eating Be Too Healthy?

Is it possible to eat too healthy if you have PCOS? For many trying to control the uncontrollable symptoms associated with PCOS like rapid weight gain with strict diet rules, can lead to an unhealthy obsession of ‘clean’ or ‘perfect’ eating that extends well beyond their nutrition.

Jamie is a client of mine who, like a lot of PCOS sufferers, gained a bunch of weight in a short amount of time. Her weight gain occurred while she was eating and following what she thought was a healthy eating style and exercising regularly.

After seeing the number on the scale continue to climb, Jamie felt she had to do something more to control her weight. Reading online, she started to cut out all dairy products. When that didn’t budge the scale down, she then cut out all gluten containing foods as well. Soon she started cutting out soy and sugar. Eventually she cut out carbs altogether. She also began to become fixated on labels and wouldn’t eat anything that had pesticides or GMOs.

Jamie became increasingly preoccupied with food. She spent hours on the internet searching for recipes or foods she could eat. She started avoiding social situations that involved food. It wasn’t until Jamie almost declined a good friend’s wedding invitation because it was a destination wedding and it would be extremely difficult, not to mention attention drawing, to bring a suitcase full of food from home, that she realized just how rigid her eating had become. “There had to be a better way.”

Jamie suffered from Orthorexia, a form of an eating disorder that is characterized by an unhealthy obsession with healthy eating.

Instead of focusing on amounts, sufferers of orthorexia tend to focus on the type and quality of their foods. Like Jamie, orthorexia starts innocently with the desire to eat “clean,” but it quickly can turn into an obsession of perfect and inflexible eating that affects ones quality of life and relationships with others. It can even lead to physical and mental health complications.

understanding orthorexia


Currently, orthorexia is not recognized as a formal eating disorder and is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The National Eating Disorder Association does recognize orthorexia and lists these common signs and symptoms:


  • Compulsive checking of ingredient lists and nutritional labels
  • An increase in concern about the health of ingredients
  • Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
  • An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
  • Unusual interest in the health of what others are eating
  • Spending hours per day thinking about what food might be served at upcoming events
  • Feeling in control when you eat the way you’re supposed to
  • Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
  • Obsessive following of food and ‘healthy lifestyle’ blogs on Twitter and Instagram
  • Not aware or responsive of internal hunger or fullness cues
  • Body image concerns may or may not be present
  • Feeling better about yourself (“perfect,” “superior”) when following diet
  • Looking down on others who don’t eat this way
  • Suffering from health related complications and/or severe weight loss from rigid eating
  • Impairment of social, academic, or work functioning

Treatment for Orthorexia

Orthorexia is treatable. The first step to recovery from Orthorexia is to acknowledge you have a problem with food and that it’s affecting your quality of life. In many cases, working with a registered dietitian skilled in eating disorders and a mental health professional to help challenge negative thoughts is crucial. Sometimes work in therapy involves exposure exercises to once fearful or forbidden foods.

Jessica Setnick, MS, RD, CEDRD-S, the Director of The International Federation of Eating Disorder Dietitians offers this advice: “Healthy eating means your relationship with food is supportive to your life, not just the actual foods you eat. If avoiding certain foods is causing problems in your life, the solution is not just to start eating them again. It may be your thoughts about food that need to change.” Setnick created this image to help evaluate what’s behind each food that you avoid.

Setnick adds “The ultimate question to ask yourself is this: Is my life better because I avoid this food? Or worse? If avoiding a food – even a food that you are required to exclude for medical reasons – is having a negative impact on your life, it is worth discussing with a nutrition counseling dietitian.”

In addition to seeking professional treatment for orthorexia, these tips are recommended:

Avoid looking at social media, especially Instagram which shows triggering pictures of food and people.
Avoid logging food or looking at food labels.
Notice when negative thoughts about food occur and be curious about them. Ask questions about the negative thoughts. Did something prompt them? Is this thought accurate or a myth?
Notice when your body is sending you hunger signals and work on responding to them.
Don’t be afraid or embarrassed to ask for help. Most likely orthorexia will eventually be recognized as an eating disorder that affects more people than you think.

You don’t have to go to extremes to manage PCOS and be healthy. Sometimes eating too healthy can actually make you unhealthy by resulting in medical complications and compromising your mental health. If you feel you may have orthorexia, I encourage you to get help from trained professionals.

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Nevin SM, Vartanian LR. The stigma of clean dieting and orthorexia nervosa. J Eat Disord. 2017;5:37.

Dunn TM, Bratman S. On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav. 2016;21:11-17.

Understanding Nutrition

PCOS Nutrition Center PCOS Prenatal

pcos dietitian angela grassiAngela Grassi, MS, RDN, LDN is the founder of The PCOS Nutrition Center where she provides evidence-based nutrition information and coaching to women with PCOS. Angela is the author of several books on PCOS including PCOS: The Dietitian’s Guide, The PCOS Workbook: Your Guide to Complete Physical and Emotional Health, and The PCOS Nutrition Center Cookbook Recognized by Today’s Dietitian as one of the Top 10 Incredible Dietitian’s making a difference in 2014, Angela is the past recipient for The Outstanding Nutrition Entrepreneur Award, The Award in Excellence in Practice in Women’s Health and The Award for Excellence in Graduate Research, from the Academy of Nutrition and Dietetics. Having PCOS herself, Angela has been dedicated to advocacy, education, and research of the syndrome.

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Comments (2)
  • Victoria Labrum

    June 19, 2020 at 12:06 pm

    This resignates with me so much! I had been working with a physical trainer who had little to no experience with PCOS. He put me on a low to no carb, high protien diet. After a few months with zero movement on the scale, he took it personally. Making it his mission to find something that would work. Our session went from fun workouts, to obsessing about foods. It lead me to avoiding all gluten, dairy, sugar(or any other sweeteners), and soy.
    After a few months of this, I felt absolutely terrible. I didnt have the energy to complete the workouts. My skin was excessively dry and breaking out on my face and arms and chest. And for the first time, I was having trouble with hair loss. And was dealing with body and gut aches almost daily.
    I had to quit and eventually went to a dietitian. They told me, eat whatever I crave, listen to my body, eat when hungry. Stop when full. It’s been a roller coaster, but now. 6months later. My skin is glowing, my hair is back to thick and shiny, and I’m gaining my stamina back. Still no on-scale loss, but I feel so much better!

  • Angela Grassi

    June 30, 2020 at 1:39 pm

    Victoria, I am so happy to hear you sought out the advice of a dietitian who can help you understand your body better. No evidence that gluten free, soy free, dairy free is good for PCOS.

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