Everyone can benefit by paying more attention to choosing healthy foods, right?

For the most part, yes. However, a small number of people seem to become obsessed with the "perfect diet." These individuals fixate on eating foods that make them feel pure and healthy — to the extent that they avoid foods with any: 

Artificial colors, flavors or preservativesPesticides, genetic modificationUnhealthy fat, sugar or added salt

For some people with orthorexia:

Preparation techniques must result in "clean food," meaning it's been washed multiple times, cooked to ensure no bacteria and minimally handled.Eating out is out of the question because it's important to avoid food that they don't buy and prepare.

The term "orthorexia" has been used to describe this disorder. It comes from the Greek words "orthos," meaning straight or proper, and "orexia," meaning appetite. According to experts including Dr. Steven Bratman, the doctor who first described and named this disorder, what tips the balance from being committed to healthy eating and having orthorexia is the extreme limitation and obsession in food selection. Orthorexics find themselves being unable to take part in everyday activities. They isolate themselves and often become intolerant of other people's views about food and health.

Studies have looked to at whether this disorder is more common in groups more likely to have a keen interest in a healthy diet, such as medical residents, dietitians, students in nutrition, fitness club members and those in the performing arts (ballet, symphony orchestra and opera singers). Each of the professions studied showed some incidence. However, the studies were unable to determine if the incidence was higher than that in the general population.

Health professionals have proposed that orthorexia be officially recognized as a new mental disorder. Currently it remains controversial and grouped with other not yet accepted disorders such as night eating syndrome, muscle dysmorphia (obsession with muscle building) and emetophobia (constant fear of vomiting).

Whether it's recognized as a true medical problem or not is beside the point. It's important to seek professional help when striving for a healthy diet becomes an overwhelming drive that takes over. Orthorexia that features obsessive compulsive behaviors can be effectively treated with medication and cognitive behavioral therapy by a trained therapist.

blog index References Bartrina JA. Orthorexia or when a healthy diet becomes an obsession. ALAN. 2007;57(4):313.What is orthorexia? Journal of the American Dietetic Association. 2005;105(10):1510.Bosi ATB, Derya C, Guler C. Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine. Appetite. 2007;49(3): 661.Kinzel JF, et al. Orthorexia nervosa in dietitians. Psychotherapy and Psychosomatics. 2006;76(6):395.Korinth A, et al. Eating behaviour and eating disorders in students of nutrition sciences. Public health Nutrition. 13(1): 32-37. 2009.Eriksson L, et al. Social physique anxiety and sociocultural attitudes toward appearance impact on orthorexia test in fitness participants. Scandinavian Journal of Medicine and Science in Sports. 2008;18(3):389.Aksoydan E, et al. Prevalence of orthorexia nervosa among Turkish performance artists. Eating and Weight disorders-Studies on Anorexia, Bulimia and Obesity. 2009;14(1):33.Vandereycken W. Media hype, diagnostic fad or genuine disorder? Professionals' opinions about night eating syndrome, orthorexia, muscle dysmorphia, and emetophobia. Eating Disorders. 2011;19(2):145.

Summer has arrived for many of us, and summer makes me think of travel and camping trips. Traveling with diabetes requires a little advance planning. Preparation depends on where you're going and what you're doing. The American Diabetes Association (ADA) provides some good travel trips that I'd like to share:

See your doctor before leaving

Ensure good blood sugar control. If your blood sugars aren't well controlled, allow enough time before your trip to improve control before you leave. I'd also recommend seeing a certified diabetes educator, if possible, for help.Get a letter and prescription from your doctor. Ask for a letter and a prescription with a list of your medications for diabetes pills or insulin shots. The prescription will cover you if you run out or lose your insulin or medications while away. However, in the United States, prescription laws may vary from state to state. When my son forgot his insulin, we went to a pharmacy from the same chain that he usually gets his prescriptions from and he was able to get a vial of insulin. Prescription laws may be different if you're traveling abroad. The ADA recommends that you write for a list of International Diabetes Federation groups — see www.idf.org.

Prepare for an emergency abroad

Know how to find a doctor. You can get a list of English-speaking foreign doctors from the International Association for Medical Assistance to Travelers — see www.iamat.org, or call 716-754-4883. If you have an emergency while traveling and you don't have a list with you, you can contact the American Consulate, American Express, or local medical schools for a list of doctors.Wear a medical I.D. bracelet or necklace. It's important to wear identification that states that you have diabetes. It could also be helpful to know how to say "I have diabetes" and "Sugar or orange juice please" in the language of the country you'll be visiting.

Pack extras

Pack extra medication and insulin. Aim for at least twice as much as you think you'll need. Keep your medication and insulin with you in a carry-on bag, because checked luggage can be lost.Keep snacks available. Bring well-wrapped, air-tight snacks such as crackers, cheese, peanut butter, fruit, and some form of sugar, such as hard candy or glucose tablets, to treat low blood glucose.Protect supplies from heat. Insulin stored in very hot or very cold temperatures may lose strength. So, don't leave your insulin in the car. Meters and supplies are also sensitive to extreme temperatures. If you're camping or backpacking, consider storing insulin or meter supplies in a cooling pack made specifically for diabetes supplies.

Understand potential insulin issues

Try to use the same insulin. Stick with the exact brand and formulation of insulin as prescribed by your provider. But if you run out while you're on the road and you're unable to fill your prescription for some reason, you can buy NPH or regular insulin over the counter in the United States. Contact a physician for equivalent doses. You can discuss this with your physician before leaving for your trip.Be aware of differences abroad. In the United States, insulin is usually sold as U-100 (100 units of insulin per mL). Outside the United States, insulin may come as U-40 (40 units of insulin per mL) or U-80 (80 units of insulin per mL). If you need to use these types of insulin, you must buy new syringes to match the new insulin. When my son had emergency surgery for an appendectomy in Ukraine, he was allowed to use his own insulin. Adjust for time zone changes. If you're crossing several time zones, talk to your doctor or a certified diabetes educator to help you plan the timing of your injections. Bring along your flight schedule and information about the time zone changes. Note that if you need to inject insulin during a flight, be careful not to inject air into the insulin bottle. In the pressurized cabin, pressure differences can cause the plunger to "fight you."

Take care once you're there

Monitor your blood glucose more often. Jet lag may make it hard to tell if you have high or low blood sugar.Carry hypoglycemia treatment. If you're more active than usual, your glucose may go too low. Carry along snacks if there's a possibility that meals will be delayed or missed.Be careful about what you eat. Avoid tap water overseas, and ask for a list of ingredients in unfamiliar foods.Protect your feet. Wear comfortable shoes, and check your feet daily for blisters, cuts, redness, swelling and scratches. I talked to a man who'd hiked in the Arizona desert for several hours; when he got home, he saw blood on his socks. A cactus needle had pierced through his shoe and wedged a quarter-inch into his foot! Because he had peripheral neuropathy, he hadn't felt it.

Lastly, it can be helpful to prepare for airport security if you're flying to your destination. Check the ADA's webpage on air travel and diabetes for more information about how security measures may affect you — www.diabetes.org.

Happy travels!

Peggy

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A while back, we had a discussion about grief and dealing with a terminal diagnosis. Many of you shared your perspectives on having a terminal diagnosis, the grieving process or the death of someone you love. It seems like another discussion on preparing for death might also be important.

Unfortunately, the word "cancer" can bring unwanted fear and anger — emotions that either you or those around you might experience. We all know that we will die some day. It's just that the exact circumstances (when, where and how) are unknown. However, rather than deal with this idea with fear, why not treat this as a time to think about living and dying with the idea of compassion and kindness for yourself and your family.

It's true that most people don't want to discuss dying, but if you're interested in finding some peace for yourself, you might consider a couple of these ideas:

Reflect on the positive aspects of your life; find strength in your deepest values.Keep in mind what is most important to you (in life and after you are gone).Write or tell stories of your fondest memories for your friends and family to reflect on now and later.Inquire early about hospice care. Getting hospice involved earlier rather than later can make such a difference. Hospice care has a holistic approach and can assist you and your family with the entire process of approaching your last days and months in a positive manner.Talk about, or write down what you want to happen after you are gone — this might include funeral planning, memorial ideas and any special requests related to the giving of meaningful personal items to others.

My wish for this discussion is to give you the freedom to reflect on the idea and talk with others about what you need.

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