When Healthy Eating Becomes Harmful: Navigating Food Stress, Disordered Eating, and Chronic Illness

For those of us living with chronic illness, autoimmune conditions, or ongoing symptoms that can be influenced by food, it can be easy to become preoccupied with what we eat. 

When trying to manage flare-ups or feel better day-to-day, food choices can feel like high-stakes decisions. 

Food fears, stress and anxiety can become very real over making the ‘right’ or ‘wrong’ choices with the foods we eat. For some, over time, this can evolve into disordered eating patterns or even orthorexia: an unhealthy fixation on eating “healthy” or “clean” foods.  

What is Disordered eating?  

Disordered eating includes a wide range of abnormal eating behaviours, many similar to those seen in eating disorders, they may not meet the full criteria for a diagnosis but can still significantly affect health. These behaviours can vary in severity and may increase the risk of developing a full eating disorder. 

Disordered eating behaviours include: 

• Episodes of uncontrollable overeating 

• Engaging in restrictive diets or frequent dieting attempts 

• Consistently missing meals or going long periods without eating 

• Inducing vomiting to control weight or relieve guilt after eating 

• Fixation on tracking calories or macros to an excessive degree 

• Tying self-esteem or identity to physical appearance or body size 

• Inappropriate use of laxatives, diuretics, or other substances for weight control 

• Fasting or chronic restrained eating 

These behaviours can affect people's physical, emotional and social wellbeing – leading to malnutrition, fatigue, poor concentration and other health issues. 

What is Orthorexia? 

Orthorexia is described as an obsession with ‘healthy’ eating. While not formally recognized as an eating disorder, it falls under avoidant/restrictive food intake disorders, a mental health condition that can cause serious health complications. 

People with orthorexia can have very strict rules around what they will or won’t eat, what is classified as a healthy food, and will fixate on specific food rules so they can abide by their healthy eating standards. 

People with orthorexia often: 

• Eliminate entire foods groups, or specific foods like those with additives and pesticides, or avoiding specific ingredients like sugar, salt or fat. 

• Have high levels of anxiety over food choices especially when a person's diet or food doesn’t meet their specific “healthy food” standards 

• Self-imposed social isolation from people who don’t align with their diet standards. 

• Follow rigid food rules that increase stress or guilt when "broken" 

• Mood swings, anxiety and depression 

• Increased self-esteem when eating foods that are ‘healthy’ 

What may start as a desire to eat well can turn into an unhealthy fixation that harms both mental and physical health. 

The challenge with chronic illness, autoimmune disease, or gut health challenges and our relationship with food. 

When managing chronic illness, autoimmune disease, or gut health concerns, food can play a powerful role in symptom management. For some, adjusting the diet — including the temporary elimination of certain foods — can bring clarity and relief. 

But this is where things get tricky. 

Because elimination diets are often restrictive by nature, they may increase the risk of disordered eating, especially for people with a history of food-related anxiety. It’s crucial to remember that elimination diets are meant to be short-term, informative, and with elimination diets like the autoimmune protocol (AIP), allow the body time to heal.  

The ultimate goal should be to reintroduce as many foods as possible and build a diet that is varied, nutrient-dense, and sustainable. 

When food becomes a source of stress or fear, it can negatively affect both our physical and mental health — limiting nutrient intake, increasing anxiety, affecting how our body utilises food, and creating barriers to healing. 

Navigating food with chronic illness, autoimmune disease and gut health issues 

There are many health supporting things we can do when it comes to dealing with health challenges that don’t require strict restrictions, where things can be added or adjusted, improving diet and nutrient intake overall, and being mindful of the dietary, lifestyle, and environmental factors that can affect chronic illness.

A balanced approach to food isn’t about perfection, it’s about finding what works best for your body, what is nourishing mentally and physically, and includes flexibility and enjoyment. 

That includes: 

• Adding more nutrient-rich foods that support our body, gut health, and reducing inflammation, instead of just focusing on what to eliminate 

• Allowing for "sometimes" foods that bring pleasure and social connection, when tolerated 

• Practicing mindful eating — tuning into how food makes you feel physically and emotionally, without judgment 

• Creating space for flexibility, enjoyment, and variety in your meals 

In some instances, elimination diets or specific food removal may be a valuable step to reduce symptoms and improve well being. However, it is important to assess each person's situation, what the most appropriate steps are for them in terms of whether foods/nutrients should be removed, added, or adjusted, for a period of time.

It can be hard to navigate this on your own, and even harder to know what’s best for your individual circumstances. This is why working with a nutritionist or practitioner who specialises in autoimmune disease, gut health, and chronic illness is so important — they can offer personalised guidance and help reduce the risk of nutrient deficiencies if significant food eliminations are necessary.

If You Have a History of Disordered Eating... 

If you’re navigating chronic illness and also have a history of disordered eating or an eating disorder, it’s especially important to proceed with care. In some cases, elimination diets or strict food protocols may not be appropriate. 

Support from a dietician or nutritionist specialising in this area, mental health professional, or eating disorder specialist, can help you find a sustainable approach to food that prioritizes both physical and emotional wellbeing. 

Final Thoughts 

With diet culture so embedded in our society, it can be difficult to separate positive health behaviours from those that may be rooted in fear or control — especially when chronic illness is part of the picture. 

If you find yourself: 

• Constantly thinking about food 

• Feeling anxious or guilty after eating 

• Avoiding food situations or social events 

• Experiencing distress when eating outside your usual routine 

…these may be signs that your relationship with food needs more support. 

Where to Get Help 

If you or someone you know is struggling with orthorexia, disordered eating, or an eating disorder, please know that support is available. You don’t have to navigate it alone. 

Support Services and information in New Zealand  

EDANZ (Eating Disorders Association of New Zealand) 
Support, education, and advocacy for people with eating disorders and their families. 
https://www.ed.org.nz 

Recovered living in Canterbury. Residential eating disorder recovery. 

https://recoveredlivingnz.com/ 

Mental health Foundation of New Zealand

https://mentalhealth.org.nz/conditions/condition/eating-disorders

International resources, support services, and further information are often easily found with a quick Google search that includes your country name. 

References 

https://eatingdisorders.org.au/eating-disorders-a-z/orthorexia/ 

https://www.ed.org.nz/orthorexia 

https://www.nationaleatingdisorders.org/orthorexia/ 

https://www.nationaleatingdisorders.org/warning-signs-and-symptoms/