On MAF Tests, Preparation and Progress

It was time for me to do another MAF Test. I hadn't done one since the beginning of the year, and even though it's a straight forward format (warmup; 3-7 miles at strict MAF; cooldown) every time you learn a bunch, not just about splits and HR. After this last round, I'm making it a monthly thing. Because, why not? It's good data collection, an MAF Tests are obviously not aggressively intense like an LT/FTP test, either, so this kind of frequency is ok. Personally I got an really good lesson on the importance of preparation and some--take note for your own tests.

So, in this post, I'll use my own data and experiences, complete with fresh input from Dr. Phil Maffetone, to give insight on how to:

- avoid mistakes before your test begins;
- use a MAF test to assess progress (or lack thereof);
- further develop the ability to be an intuitive athlete (whether coached or self-coached);
- use MAF results to structure/tweak training going forward;
- use these tests to avoid accumulating too much fatigue, overtraining or plateaus;
- correlate the tie in's with health, stress and lifestyle.

For a refresher on MAF Tests or if you're new to the concept click here. And to make sense of the heart rate (HR) info I discuss and why 150 is my number, click here.

~~~

Lead-up Preparation

So let's start here. You can examine exactly what I did exercise-wise in the week leading up to MAF testing, starting 11/14/15. Note that when I was doing the 30k I wasn't even thinking about a MAF Test coming up in the near future.

Sa- 30k trail race
Su- IMAZ spectating/sherpa'ing
M- Off, rest, travel day
T- 60' weighted hike (mostly flat)
W- AM: 8 mile ez trail run (sub MAF); PM: 60' strength (functional + weights/KB circuit)
Th- Incredibly ez activity (aka day of movement). AM: 40' fasted spin on bike trainer; NOON: 15' non-wetsuit ocean swim/flop; PM: 40' easy walk no vest
F- 15' slow weights (inc. KB swings); 75' SUP- 1mi ez/1mi hard/1mi ez + "SUP farmer carry;" it counts ;)
Sa- MAF test, round 1
Su- MAF test, round 2, yes, you will see....

Food factor: Friday pre-test I felt fresh and like I could have done more, but I didn't. Then dinner happened. I got creative, making some grain-free pizzas, experimenting with a few "clean" crusts and topping combos. That's fine, but there was cheese. Quality cheese, and all variations that I've been ok with in the past, but cheese. Lots of it. I ate too much of it. Not wise for a gal who's essentially dairy-free and still in recovery from severe gut issues.

~~~

MAF Test Round 1: Ugh

The next morning I felt the cheese effect. I woke up as usual about 5:45 but my gut was in knots. I went to the bathroom 3 times, not good news there. Damn dairy. I decided to wait it out a bit instead of starting the test right away. I had some breakfast and cold brew. Headed out around 9:30 en route to the track, and--in typical crazy SoCal style--it was a fall heat wave with dry, santa ana wind conditions.

I was not feeling well at all (and now I was slightly dehydrated from the bathroom situation), legs heavy, breakfast not fully digested. I thought, "maybe it was the weights and SUP this week; maybe it's still the 30k in the legs; maybe it's the f*$&ing dairy... maybe it's all that... maybe I should shut up and just try." I ended up prolonging the warmup to 40 minutes (!), which consisted of walking, sub-MAF jogging, and eventually settling into some MAF intervals on the track. It was hot by the time I started. I was trying not to chug my water, but I was thirsty--a red flag.

The Saturday test went like this:

Mile 1- 8:40
Mile 2- 8:53
Mile 3- 9:06
yup only 3 miles

Avg: 8:53

HR was wanting to be high-ish around mid-150s instead of steadier MAF ~150, and by mile 3 it was already creeping to 160 forcing me into a couple walk intervals. I'm sure the caffeine played into this.

I may not do a ton of MAF tests, but I've run MAF enough, and I knew this was not normal data for me at all. Body was dragging, and HR was wanting to be way too high for the pace/effort. Intuition clicking in...

During that third mile I could see the writing on the wall and decided to pull the plug because I had an idea brewing: Instead of forcing this shitty test, I would stop there, recover like a rockstar for the rest of the day, eat like a champ, and re-do the test the next morning. Since it's a MAF test, aka aerobic and moderate, doing a repeat test that soon is fine; I would not recommend the same for LT, FTP and VO2max tests though!!

Dr. Phil Maffetone agrees: "The back to back MAF Tests are OK. Normally, when healthy, you should be able to run at MAF regularly. Many people can train daily at MAF."

I was frustrated that I perhaps sabotaged the test, but I made my peace with it. I was actually motivated and fired up to give it another go and do better--I knew I had a better performance in me. The rest of Saturday I laid low, did a little cold therapy in the ocean, ate a "safe" dinner (no trigger foods), and got to bed early around 9.

~~~

MAF Test Round 2: Not giving up so easy

Sunday I woke up without an alarm around 5:15. Lately I'm sleeping like a rock again, uninterrupted sleeping bliss almost every night. I woke up feeling ready to dominate. Preparation success this time.

For the second MAF test I opted to do it even earlier and fasted, no coffee nor breakfast before (not hungry), beat the heat. I had a glass of water with lemon juice; typical morning ritual. Had a good/normal poop (sorry, TMI, but yay) and got going. My fat-adaptation is great so I don't need food or caffeine in order to function, and my body is used to fasted workouts; however, I'm certainly not training fasted all the time, too risky.

I wore the same shoes, did the same warmup route, and got to the same place--the high school track--well before sunrise, at about 6am. This time it was cooler in the 60-70s, not 80-90F hot pounding sun. I wasn't feeling 100 percent fresh and springy, but I was certainly feeling better than Saturday. I needed less warmup, about 25-30 min of the same protocol: walk, sub-MAF jog, finishing at MAF for a couple laps. I like to make sure I get in just a bit at MAF before I start the test so my body easily slips into and stays that mode once the test starts.

The Sunday test went like this:

Mile 1- 8:16
Mile 2- 8:22
Mile 3- 8:36
Mile 4- 8:41
Mile 5- 8:44

Avg: 8:32

Overall avg HR was 152, and I was able to much better control it around 150. I don't have an alarm on my watch, and I also don't stare at my watch the whole time I run, so I know it bounces around a tiny bit, but generally it was on target for MAF (sometimes even sub 150). Hydration on Sunday was so much better/normal. I only "needed" about 100ml of water for this workout, vs. saturday when I drank 700+ ml.

Decent splits, and nothing earth-shattering but a stark improvement from the day prior, even in just how I felt. (That day I had great energy--saw a client at the gym, tooled around on the SUP, and went to a friend's party. No soreness/fatigue from the tests.)

Lessons learned on preparation:

1. Don't eat potentially sketchy and/or trigger foods in the 24-48 hours before a test.

2. No caffeine before a MAF Test.

3. If metabolically efficient (fat-adapted) consider doing the MAF test fasted, or at least on an empty stomach.

4. Don't discount weather and its effect of performance.

5. Try to avoid anything overly strenuous (i.e. a race, hard strength training) in the week before a MAF Test.

~~~

Analyzing Results 
Ok so there's that. Fun right? Now, what to make of these numbers?! Because what's testing without geeking out over results and data ;)

Comparing Tests
These recent splits are all slower than the MAF test I did in January. Not a ton slower (still within 30 seconds of the average then), but still slower. Hmmmm. So then I start to question all the things like any coach and athlete should do:

My specific questions, and ones you can ask yourself!

1. Was I simply too fatigued when I tested? (That 30k! Re-test?)

2. Is slower ultra training making me slower? 

3. Is my overall training "not specific" enough for a better MAF Test result?
(Not enough time training at MAF?)

4. Other factors: Could it be an underlying health issue or stress? 

5. What to do going forward?

6. Do MAF Test results even matter, especially if I feel good and am happy?!?!?

Fresh vs. fatigue factor
January: I was arguably more fresh/rested overall coming off an extended 5-month rest break July-Nov 2014. I had transitioned to moderate MAF-based marathon training, 6 weeks later tested.

Currently: The 30k race/travel happened, and I guarantee I didn't do a 30k right before the January test, lol. Plus other potential variables may have skewed results. As for overall training fatigue? Ya, we've been actively building volume and time on our feet. No, I am not exhibiting signs of burnout/overtraining.

Specificity of training
January: I was at about ~6 weeks into a MAF-specific running (20-30 miles per week (mpw)) program. It was all about training for a marathon at MAF!

Currently: I'm not running exclusively MAF anymore. Instead, my running/hiking is majority sub-MAF (under 150 HR) and slower paces, but more mpw. I do occasional but inconsistent longish runs at all MAF, plus sprinkled in hill repeats or strides. The rest of my training is crosstraining, which varies in intensity.

Training Breakdown, Aug-Nov:

42% - running

35% - hiking and walking*

12.5% - strength training

10.5% - other (bike, sup, swim)

11:30 - average weekly volume 

(15hr/wk at most)

*this includes strenuous hiking, some backpacking, weighted vest hikes, 

and recovery walks--all types of intensity.

Health
I feel fine, but who knows. So, this is why you test. I'm getting blood and hormones re-tested soon, and also a gut/stool re-test to check status of the nasty infections I've fought: H. Pylori, SIBO, and candida.

Dr. Phil Maffetone chimes in!!
Summary of what Phil had to say in response to my questions: 

Feedback: "Of course, you were a bit trashed the first test on Saturday. No surprise that stress raises the HR and slows the pace. Only part of this was due to the previous week's race (then add travel stress, food stress, etc.). The second test was much better... What would the results be after another week or two when you were fresh? Maybe even better, with appropriate recovery! I don't think the slower training is make you slower, but rather the stress [this includes life stress too; see below]."

Going forward: "Maintain once- or two-a-week MAF runs when your body is feeling like it can do that well, and for as long and as often as your brain dictates. Re-do a MAF in a week or two, and hopefully it will be faster than 8:16 on the first mile. There's no reason to reduce training leading up to a MAF Test. Just make sure you're recovering really well (especially sleep, and no muscle soreness). Might be good to reduce or eliminate any strength training until your MAF test improves. The primary need is to remain healthy."

Takeaways from Phil:

1. Be an intuitive athlete and exercise the brain not just the muscles.

2. Health comes first. And there is a way to be healthy, get faster and have success in ultra. (Phil did NOT say it's probably a good idea to pull the plug on ultra training.)

3. Be honest about your overall stress, and manage it.

4. Recovery is paramount.

5. Less is more.

~~~

The Plan Going Forward
With this one little weekend of MAF Testing, I have so much more clarity and a plan:

Train smarter not harder
My recent training is making me a better long-slow-distance (LSD) athlete who physically and mentally has no problem being on foot for 3-6 hours now, which is good because that was always lacking in my years doing triathlon (my long runs were traditionally 90 minutes). But I believe I'm starting to plateau and/or am being too random with training--random just like I was before the marathon this year before buckling down. So, I'm going to experiment by laying out a bit more structure in the form of a "MAF-based polarized training approach" rather than just winging it. Polarized training is proving to be safe and very effective, and I'm intrigued by it which I'll discuss more in an upcoming post. Basically for me it means I'll avoid the "gray zone" in all of my training, work the aerobic (sub-MAF+MAF) and also work the high-end anaerobic (over threshold). The goal here is to train smarter not harder and always adhere to smart recovery.

It's fine to have a generalized (random) approach to get a good base level of fitness and athleticism, but then the plan must come together with specificity for the sport--these are the basics of periodzation (and you can periodize whatever style of training you want whether a traditional threshold-based program or the MAF Method or in my case a hybrid of MAF+polarized). Meanwhile, it's always important for athletes to be flexible with the plan, intuitive and go-with-the-flow (i.e. bail on a workout if fatigued; add volume if feeling phenomenal; add recovery when needed even if the plan says workout; etc.), and not be a mindless robot executing a pre-set schedule. Don't disconnect from listening to the body.

On more recovery
Generally, I don't think too much training stress + not enough recovery is my problem these days. I even re-checked on TP, and I'm very good at taking one day off a week on average, sometimes two days off if I feel it's needed, plus having very easy recovery days. I'm not afraid to rest from training (or life) anymore. My weekly training volume is clearly not insane. I don't get wrapped up in needing to be like other runners who are doing 100-200 mpw; I do what's right for me. I think the slower MAF Test was just more acute fatigue, not me blowing up again. I'll plan MAF Tests better so they're consistent with reliable results. Reliable, meaning I do generally the same things in the week-ish leading up to a test.

Better focus on stress management
Putting the training/race fatigue factor aside, I got to thinking more deeply about my overall stress and non-training stressors, realizing it was time to touch base with these things again. I got really good in 2014 and into 2015 of finding a peaceful, low stress and more chill approach to life that works for me, and I consciously eased up on my aggressive Type A tendencies with tremendous success. But I can see in recent months how I've slipped up here and there and am tending to push myself hard again, in more ways than one. I recognize it. I will reel myself back in. It's funny, on a recent NBT podcast with Dr. Tommy Wood and Chris Kelly, they discussed that even as health practitioners who know the tools for optimal health, they still struggle because they have sh*t to do, big goals, and often crazy demanding schedules. People like us have chosen these lifestyles, and I think they're admirable ways to live, but we often need to step back and take a dose of our own medicine...

John and I are always on the go and living it up, I love our crazy life, but I know I have a hard time just relaxing especially when I feel good. I just like to be doing things. I love my work, so I work a lot even work on weekends. I love adventure, so I hate just sitting around at home. August/September had something "big" (often requiring travel) nearly every weekend--backpacking trips, music festivals, weddings, vegas and even food poisoning for me. Then October was a tough month--don't hate but for real, Kona/Ironman week was (as always) very demanding and I burn myself out, while drinking way too much coffee (my poor adrenals). Even our few days in hawaii post-Ironman are all about adventuring (probably not enough R&R). Then after kona, I had a hard time emotionally revisiting some past life things, aka the anorexia, which had been shoved down in me and needed to come out to get more closure and peace. Letting things out like that are great, but they still take a toll and are a stress. I have also been clearing out that H. Pylori infection and my gut/digestion issues have been a roller coaster. November has been starkly different in that I've back to better balance, fewer stressors and breakthroughs with gut issues (as such, I'm sleeping better as mentioned earlier). But I know the calm periods don't last forever. I fly out of town next week and will be pulling close to an all-nighter at John's 25-hour endurance car race, then the holidays, and most of all: Our 2016 is going to be a huge year for us. It's on me to work harder than ever at stress management, self-management and prioritizing. If we're going to race ultras and get married next year, among all the other plans, I need to manage my life so that I remain healthy and perform optimally. There's no negotiating this. It means everything to me to put health first.

Do MAF Tests matter?
Yes. But I also want to emphasize that it is not my goal to become an elite ultrarunner or the fastest chick around. I just want to be healthy and continue to be able to put one foot in front of the other for a long time. So the MAF Tests for me are check-in's to make sure I'm in a good state of health, managing stress, not overtraining and not undertraining either. My training is also a constant ongoing experiment in how to further understand endurance athletes in order to be a better coach. Learn by doing.

Strength Training?
Lastly, where I might actually disagree a bit with Phil is in his opinion that I eliminate strength training (ST). "That will give your body a change to focus more on re-building the aerobic system--something that's most important right now for health and a great fat burning foundation, and before building more miles and more strength," he says.

Valid point, and I agree that I shouldn't be doing ST that wrecks me, compromises my running and leaves me with ridiculous DOMS, especially the week before a MAF Test. However, I think that some ST--whether an easy functional routine or an occasional heavier weight session or slow weights--is important for health and balance so it's not simply chronic endurance. The ST keeps healthy muscle mass on my body; I don't like getting too lean from just aerobic running nor is that healthy IMO especially given my history. I don't personally think my approach to ST is overdoing it--I rarely break a sweat during sessions outside the occasional day of sledgehammer swings ;) And most of all, I love ST. I don't want to stop. It's fun, it keeps me functional (mobility and stability), strong and injury-free. But I won't completely rule out his advice.

...ok, your turn to MAF Test!

Analyzing Healthy Eating vs. Eating Disorders (including Orthorexia), and The Need to Get Out

Whoa long title... but lot's to follow up on in regard to my last post.

Among all the lovely comments, emails and replies to the anorexia post (btw, thank you!), a couple stood out, which makes me want to dive deeper into this very important conversation. Basically the jist of those comments was, "But, Tawnee, it is OK to 'fear' today's food, ingredients and restaurants!"

The folks who said this, folks whom I highly respect for the record, suggested that it's better to prepare your own food (aka cook at home), be seriously skeptical of the restaurant industry and what really goes on in their kitchens (especially in the U.S.), and find ways to socialize or go on dates that don't center around food and dining out.

Valid points.

However, I said, "Yeah, but it's different if you've had an eating disorder (ED). In fact, it's really complicated...."

Letting Go of Control and Loneliness
For one, I've had to work my ass off to overcome some serious fears over food, control issues with food, body dysmorphia, and self-imposed social isolation. When you're suffering from an ED, you are lonely--extremely lonely no matter how many people love you and how many friends you have. And loneliness is not fun. In fact, the latest NBT podcast with Dr. Bryan Walsh explains how loneliness has very negative impact on gut health and overall health. I had to step up and stop isolating myself. There where times where I'd go hide in my car at SDSU (while it was parked in a hot parking structure) to eat my "lunch" for fear of people seeing what I actually ate, and what they may think of me. Those were sad times. I've had to overcome anxiety eating in groups (even with family!), anxiety over dining out, and anxiety over what my body looks like to the world. Thus, it is incredibly important that I continue to GET OUT and make sure I don't get "stuck" in my safe place at home, eating my "safe" meals. Not only physically get out the door to sit at a restaurant but also build up the comfort and confidence to enjoy the company of others--and not feel isolated but rather feel engaged, connected and truly part of a group. (And this isn't just specific to those with ED's either; think about how often we're lonely when we're around others; in or cubicle or social media are good examples too....)

Not to mention I love the experiences and life-lasting memories that often come from dining out--even at the risk of a few less-than-perfect ingredients. John and I have had some amazing times, amazing meals, and guess what? I survived, and he and I thrive as a couple. Plus, since 80 to 90 percent of the time I am cooking at home and eat an incredibly clean diet (even when we travel we do VRBO to get places with kitchens so that we can home-cook some of our meals) I think that extra 10 to 20 percent of the time I'm perfectly ok stepping outside into the world and take risks--and so are you.

My risks don't include "extreme eating" like sketchy hole-in-the-wall buffets, questionable hot dog stands, Outback Steakhouse-type fare or fast-food joints, etc. Hell no! I'll sit out on eating truly bad stuff, and/or go there to be social but not eat--then before (or after) eat something better quality. When we dine out, I am usually very conscious of choosing good restaurants, for health reasons above all--not for the need to control/restrict calories or lose weight. Ok maybe I am too conscious at times of searching for "the perfect" restaurants (getting a little obsessed with Yelp), but I truly care about fueling my body with the best quality foods possible--organic produce, free-range/grass-fed meats, wild fish, healthy fats, locally sourced fare, etc. Especially since I have knowledge (maybe too much knowledge) on nutrition and today's food supply--it is a scary world out there if you're not careful--and because I want to fuel for performance in sport and life. I'm the first to agree, and recommend, that we should give a lot of thought and concern into the the quality of food we eat, the restaurants we choose, and the meals we cook at home.

Happy times at a random restaurant in DC...

...trying creamy, buttery escargot--worry free!

New-Age Eating Disorders
This begs the question.... what's the healthiest approach? Does it always have to be about adhering to the best-quality ingredients, or should we let go more often--let go of the associated stress that comes with seeking perfect food--and be more free and go-with-the-flow. If you get too wrapped up in always trying to eat a perfect, pure, healthy diet, you go down a scary road--one that's lonely and isolated--and risk developing a new-age eating disorder known as orthorexia, the obsession with eating healthy food to the point where it disrupts your life, behavior and happiness.

I've thought about it in my own case: Has my ED past manifested into some form of orthorexia? Are my aforementioned friends who told me I should fear the food and only cook at home also orthorexics? (They both work in the functional health field, after all.) There's plenty of reason to believe, as you'll see below, why a former anorexic could easily fall become orthorexic. I don't want to think that's the case with me... and I'll argue why I don't think I'm orthorexic. But at the same time I don't think you'll ever catch me eating McDonald's or even the salad at Chuck E Cheese's, ever.

So now to the meat of the post. I've got some 'splaining to do. 

Breaking it Down
Gets confusing though, right? You're telling me. There are multiple situations going on, and they can't be lumped together. What the former anorexic feels--often irrational fears--is very different than what a non-pathological human feels when going to a restaurant with intent to eat healthy--which is different but similar to the orthorexic. Thus, my friends who promote cooking at home have a fair, valid point, but they have to understand there are reasons why I choose to eat out that are more important to me than ingredients alone. Below I'll attempt to distinguish the differences among the types of people we're talking about:

Person 1: 

Those who strive to eat quality/healthy food but are flexible with no disorder

Person 2: 

Those who've suffered from an eating disorder such as 

anorexia nervosa ("AN") and/or bulimia nervosa ("BN")

Person 3: 

Those who've developed Orthorexia Nervosa ("ON") by taking healthy eating too far

Person 4: 

Those who are all or some of the above

It could be a good practice to find out where you fall on the spectrum in your quest to develop a healthy relationship with food, your body, your mind, and stress levels--and to avoid any loneliness or isolation caused by fear over food.

Person 1: Health-Conscious but Non-Pathological 
This is the person who seeks healthy food and clean ingredients for smart reasons, with no underlying pathology. Their reasoning to eat healthy may include achieving and maintaining good health status, avoiding harmful substances (i.e. pesticides, GMOs, chemicals, additives, hormones, etc), disease prevention, and building a well-functioning body that's not overloaded with sugar, gluten and other disruptive forms of food. Or it's the person who wants to eat healthy and clean as part of their health and fitness routine--perhaps they're in high training mode and need/want to feel their best, or they achieved great weight loss and don't want a setback. Or it's the person who's doing it for more ethical and moral reasons. With the increase of documentaries, books and articles exposing what really goes on behind the scenes in the food industry--from poor treatment of animals to GMO crops--some folks will not support these poor practices and avoid conventional foods for better alternatives--they consciously seek labels that say "organic" or "free range" or "grass-fed" (hint: labeling something "natural" doesn't count--that term is total BS with no governing regulations). Person 1 may develop a sense of pride in choosing quality over the "evil"' stuff, as well as realize how much better quality food in terms of its nutrient density, nourishing properties and superior taste*. Or maybe Person 1 doesn't even care so much about health-food per se, but simply realizes that junk food and empty calories make her feel like crap--and she chooses not to feel like crap.

That said, Person 1 is not overly obsessed with only eating healthy, quality, pure food. She likely has no pathological condition surrounding food or her body and its size/shape. She allows for balance--realizing we can't all be perfect--and sometimes living life means the occasional situation where the food may not be the best, so she adapts, doesn't freak out and understands that the 80-20 rule (or some variation) will ensure she'll be okay. For example, she's flexible and willing to eat most things at holiday gatherings or parties, she can find something to eat at most restaurants or during travel without any food-related stress, she's okay having the occasional "conventional" piece of birthday cake or pizza. Person 1 has good intentions to eat well, but realizes we can't be perfect so we can just do our best, and the idea or reality of a "bad" meal or "bad" day of eating won't shatter her world or have lasting psychological implications like anxiety, fear, doubt, and obsessive thoughts.

Bottom line, she's not eating the Standard America Diet ("SAD") by any means, and rather is much healthier and making conscious decisions for clean, quality food the majority of the time, but she is flexible and doesn't see food, or control over food, as a source of stress.

Btw: I think my fiance, John, is person 1, and I admire him. He definitely makes efforts to eat as healthy as possible but realizes it'll never be perfect, so he doesn't stress it and instead lives a balanced, happy life and goes with the flow. Could he be healthier in his meal choices at times, sure. Does he know that? Yes. But at what price? Maybe more stress that then makes him less healthy?

~~~

Person 2: Healthy-Eating-Turned-Orthorexia
For argument sake, let's assume Person 2 does not have a history of an eating disorder nor a per-existing condition. It started out innocently enough: She got on a health kick, liked how it felt, saw results, and even liked how it felt to be part of an "elite" community of fellow healthy-eaters. She spent free time reading/following blogs and websites on nutrition, clean eating and healthy recipes. She started obsessing more over "pure" eating, eliminating anything that was not deemed healthy, and even letting her obsession with healthy food cut into her social life by declining invites if she knew there's be unhealthy options. She'd get angry if she couldn't stick to her healthy routine, fussy if ingredients weren't up to par. It snowballed, and healthy eating went too far turning into the latest of eating disorders: orthorexia.

Orthorexia was coined by Steven Bratman, MD, in 1996 and literally means "the fixation on righteous eating." Although it's not listed as a disorder in the DSM-5, it is an increasingly growing REAL eating disorder in today's population, and happens when people who let a once-innocent desire to eat clean, quality, and pure go too far. The quest for quality food dominates their life. How does it differ from healthy eating? According to Dr. Bratman, "healthy eating is a conscious choice. Orthorexia is an obsession with healthy food that involves other emotional factors and has become psychologically and perhaps even physically unhealthy. It is an eating disorder."

I can certainly see this being the case for many athletes, especially endurance athletes, who are very in tune with their bodies and very particular about the food they allow in order to look and perform a certain way. In fact it took two seconds to find research validating that theory. On one hand, I think it's fair for an athlete to be strict with diet--or any human, it doesn't have to be athlete--but how do you know that strict approach has gone too far?

When it invades your life and "creates psychological distress and impairs various life dimensions, but does not present a physical danger," says Dr. Bratman (who recovered from orthorexia). Dr. Bratman was also quoted on nationaleatingdisorders.org saying, “I pursued wellness through healthy eating for years, but gradually I began to sense that something was going wrong. The poetry of my life was disappearing. My ability to carry on normal conversations was hindered by intrusive thoughts of food. The need to obtain meals free of meat, fat, and artificial chemicals had put nearly all social forms of eating beyond my reach. I was lonely and obsessed. … I found it terribly difficult to free myself. I had been seduced by righteous eating. The problem of my life's meaning had been transferred inexorably to food, and I could not reclaim it.”

Still, there are some who think it's silly that healthy eating could be considered a terrible thing, but in my eyes--as someone who's lived through an ED--I don't think it's too silly at all. Those addictions and obsessions can go too far, I think. However, I would NOT consider ON on the level of AN or BN.... I just wouldn't...

More on healthy eating vs. ON - and don't be a "wannabe orthorexic."
Here's a test used to assess ON. 
Here's a critical look at ON.

~~~

Person 3: The Recovered ED
I don't want to take the space here to define an ED other than they are mental disorders, often life-threatening; read more here. What I do want to distinguish is the difference between ON and other EDs: AN/BN are more related more to the quantity of food, while ON is more about quality. AN/BN patients seek an ideal body image, while ONs seek a pure body. Usually there are strong biological roots in AN/BN cases (my story supports this), whereas I would argue that ON may be more of a phenomenon of our modern world (and the person with the "right" traits falls victim). ON often has roots in obsession to look good and fit in, including on social media--AN/BN not so much. Not too many ANs want to post full-body selfies. Instead, AN/BN often reach a level where they knowingly don't take care of their bodies--they realize the harm but still continue on. TO complicate it further, as you will read in Person 4, it seems that these days the lines are often blurred between ON and AN/BN.

So for the Recovered ED (aka Recovered AN/BN), it's complicated... there are stages to get through. Let's assume we're talking about someone in a maintenance and relapse-prevention stage, or beyond. Whether you finished rehab yesterday or 20 years ago, it doesn't just shrivel up and die as soon as treatment is over. If you've never experienced an ED don't assume that this illness can be expelled from the mind and body once and for all.

There's a lot of shit that can still surface, those unwelcome inner "demons" that rear their ugly heads:

1) Sometimes food choices may or may not not have pure intentions about healthy, clean eating. Perhaps eating healthy is just another manifestation of restriction or quantity control. Research supports that some Recovered ED's still have a strong urge to control food, ingredients and/or weight even in the management post-ED phases, and healthy eating or having dietary restrictions (i.e. vegan, gluten free) is the perfect excuse; for more see Person 4.

2) Maybe exercise addiction is still present along with body dysmorphia and the need to control weight. The Recovered ED may be a normal weight but inside feels strong impulses to keep strict control over bodyweight, fears getting fat, and maybe even feels fat or obese even if that's not the case. An "easy solution" is to take up a sport that requires a lot of training, or some highly-regimented fitness routine. There's a bit of comfort found in the calories-in, calories-out equation.

3) Speaking of punishment, it's hard for the Recovered ED  to let go of feelings of guilt and self-hate. For example, say she over-indulged--not binged--but simply enjoyed eating whatever food was present and let go of that damn voice telling her to control. It felt so good for a second--free and liberating--but then... then the guilt set in. The desire for self-punishment and future restrictions started brewing... 

4) Or, there is some presence of obsessions, the need for control, and anxiety issues. There are still "pizza stories" that pop up. Perhaps these obsessions manifest into a new issue. Enter Person 4.

I could go on... keep in mind I'm highlighting the problematic behavior for a Recovered ED (for the purpose of this post) not the positive gains they've made. Whatever the problem is, it's all about self-management and belief in one's self that they are better than the ED.

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Person 4: The Recovered-ED-Turned-Othrorexic
Yikes. Person 4 is not just someone I made up, there is strong evidence in the research of this being and actual person. This study, for example, had a small sample size, but it showed how "easy" it is to develop ON if there's a history of AN or BN. ON symptoms are highly prevalent among patients with, or recovering from, AN and BN. ON tends to increase after treatment of and improvement from AN/BN--it's migration toward a "less severe" form of an ED.

I see how this can be. Coming off AN/BN it seems very logical that one would develop a new obsession for eating healthy--the obsession for quality, to some degree, replaces an obsession over quantity. Let's assume that she even lets go of obsessing over weight loss and calorie control. Now the obsessions are about organic, gluten-free, chemical-free, etc--all those distinguishing variables I listed with Person 1 (oh, Person 1, it was so simple then lol). Again, seems innocent enough, right? But not so fast...

Since there are biological roots in someone who develops AN/BN, the new ON obsessions may trigger the same old anxiety or irrational fears over food, and bring back the same old habits, rituals and tricks. More and more food is "off the table" for being considered edible, dining out once again becomes a problem (god forbid eating non-organic), there's more secrecy and seclusion surrounding food. The fun is taking out of food, anxiety comes back, and the quest for healthy food is no longer pure. All of a sudden it appears a worse relapse may be occurring: social isolation, psychological disturbance and even treating the body maliciously again.

Perhaps even the desire to control weight and calories comes back. Dr. Bratman says there are "covert anorexics" who use healthy food as an excuse for low calorie. Even the diagnosis of "anorexia" now includes one's desire to eat healthy food--not just restriction. Equally confusing, there's research to support that some orthorexics start to take on AN/BN behaviors like binge/purge or severe restriction and weight loss obsessions. It gets to a point where you have to question what really is going on here? What's the diagnosis?! It's complicated!

"Today, the majority of people with orthorexia may best described as having orthorexia with anorexic features, and a large percentage of those with anorexia as having anorexia with orthorexic features," says Bratman.

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Final Thoughts
I can't help but think about where I fall.... I wish I was Person 1. I'm not quite there. I'm likely some hybrid of a Recovered ED with ON tendencies--but I certainly don't consider myself to be ON. If I weren't careful, I probably could go down that road. I won't go down that road. I don't want to be lonely and isolated due to food ever again. So I have to be proactive. How so? Keep it real. Go outside my comfort zone. Face situations that will allow me to toughen up and manage it. I don't like going out of my way to introduce stress (like the pizza episode), but sometimes risking a little potential stress up front ends up saving a lot of big stress down the line--and could even promote better health going back to the Bryan Walsh/NBT podcast. It's the same with sport, the podcast, entrepreneurship, even backpacking--none of these things are "easy" and there are definitely associated stresses and fears at times, but that doesn't mean I hide from them by quitting or getting a "safe" desk job instead. I step up to the challenge--and I also become a part of some great communities as a result, making life-long friends and lasting relationships in the process. Just look at lucho and I--he's my BFF! All because I got over myself and public speaking fear to do the podcast AND bring on a co-host who at first intimidated me due to his amazing race resume/reputation.

So with food, hell yea, I will proudly eat healthy and clean, and hell yea, there are still certain unhealthy foods that I'll absolutely refuse to eat for health reasons. But I'm equally set on branching out and maintaining balance and quality relationships--let me say that again QUALITY RELATIONSHIPS. I do my best to maintain an open mind and a flexible approach and attitude. I don't want to go down a path of stress, isolation, loneliness and misery just because of food... 
Sometimes that means facing those very stressors to stand up to them, and sometimes I have to fight really hard to overcome the old demons. But I got it. I can and will stay strong. Attitude prevails.

ED or not, maybe we can all take this as a lesson to ease up a bit... don't always stress... think deeply if you are feeling lonely or isolated (for food reasons or otherwise), and know that we won't be perfect, but there are tools to have a damn fulfilling, fun life--pizza included.

What do you think: 

How far should we take our healthy habits? How far is too far?

Have you ever felt lonely or isolated because of your eating habits/dietary needs?