It's no surprise that a lot of Americans watch what they eat. Counting calories, nutrients and fat grams is practically a national pastime.
But what happens when people go over the line, and the pursuit of healthy eating actually becomes unhealthy?
For Johnny Righini, a 26-year-old from California, eating a nutritious lunch is a painstaking ritual.
"Sometimes it takes days to prepare meals, because I have to sprout things, ferment things," he said. "I am constantly thinking about what I am gonna have for my next meal."
Charlotte Andersen, a 29-year-old Minnesota mother of three, says she went through the same thing.
"It really turned into a huge problem, and I think that there are a lot of other people out there that have this issue," she said.
Food took over her life. She compulsively catalogued everything she ate.
"I was obsessed with things like macro-nutrient ratios, numbers, charts," she said.
She realized she had a problem when she started paying more attention to food than to her own children.
A New Kind of Eating Disorder
What Righini and Andersen are struggling with is a kind of an obsessive compulsive disorder focused on health food called "orthorexia." The term was coined by Dr. Steve Bratman, author of the book "Health Food Junkies."
Bratman spent years in the health food movement, but became one of its critics after he realized he had started to become orthorexic.
"I suffered from a psychological obsession with food," he said. "When I was involved with this, it took up way too much of my life experiences when there were other things I could have been doing."
Orthorexia is different from anorexia, Bratman said.
"Anorexics seem to always think they're fat," he said, but "orthorexics know they're thin, but they want to be pure."
For people like Righini and Andersen, orthorexia is "a disease disguised as a virtue," Bratman said, because society approves of health consciousness. Americans spend millions on diet books hawking things like macrobiotics, the Zone, the Blood-type diet. And dieting is OK, up to a point.
"But when it gets to the point where your health is overtaking your life, I think that's when it gets to be a problem," Andersen said.
Striving for Purity
Because they pursue purity in the food they eat, orthorexics are disgusted by processed food like macaroni and cheese. And Righini said even something as seemingly innocent as an apple could be toxic, because "if it's not organic, probably what goes into the soil is going go into the food, and then it goes into you."
With toxins lurking everywhere, orthorexics end up avoiding much of what most of us eat.
"I took out tropical fruits, because they were too high in sugar," Andersen said. "I took out root vegetables, because they had too many carbohydrates."
Andersen couldn't eat at restaurants or friends' homes, fearing she would be pressured to eat impure foods.
"I was afraid that if I got anything wrong I was going to get cancer," she said.
And plenty of diet gurus will tell you, Andersen was right to worry.
"You become what you consume. You consume dead food, and death accelerates its presence," diet guru Viktoras Kulvinskas said.
Kulvinskas is a leading advocate of the "raw food" diet.
Raw foodists believe cooking vegetables even a little destroys their nutritional value. And eating meat is even worse, Kulvinskas said, because you eat the animal's fear.
"When they go through slaughter, they go through a lot of fear, and that fear is taken into the dietary habits of America."
Everyone knows that eating too much meat can be a problem. But does Kulvinskas even make sense? All over the world, as people have gotten wealthier, they are eating more cooked food, more meat and life spans keep increasing.
"That's correct," Kulvinskas said, adding that people are "sicker than ever. Living longer doesn't mean quality of life. It only says that you're living longer under medical intervention. These are not natural, whole people."
Kulvinskas believes a raw food diet is the only way to be healthy, but according to Bratman, "a raw food diet is tricky. It's easy to not get enough calories in a raw food diet."
While raw foodists can be healthy if they rigorously follow the diet to get essential nutrients, "the theory itself doesn't focus on those nutrients, usually. It focuses more on the spiritual qualities of the food."
Of course, for some people, spending so much time thinking about health food is no worse than other fanatical obsessions, like hording or compulsive shopping. But orthorexia can really hurt people.
A Family's Heartbreak
"I began to hear stories of people who took this to such an extent that they harmed themselves, physically," Bratman says.
One of the people Bratman heard from was Kate Finn, a former gymnast from Rhode Island. Finn developed orthorexia after she moved to California and began trying diets like raw foodism.
"She was so absorbed with cleansing her body of toxins ... that was her lifelong goal," said Erin Finn, Kate's sister.
In the quest for purity, Finn eliminated more and more from her diet. Her appearance deteriorated. "The beautiful, vibrant Kate had really become someone that looked much older. People would stare," Erin Finn said.
Finn wasn't anorexic. Erin Finn said her sister knew she was underweight, but she insisted on eating only foods she considered "pure."
Like Charlotte Anderson, Kate Finn kept a diary documenting her desperate descent.
One entry reads, "What do I do to gain weight? I'm afraid, confused."
Finally, Finn agreed to let her family take her to a hospital.
"Our niece went to pick her up," her sister said, "and found her."
But it was too late. She was discovered dead, at age 37. As Finn's family read through her diary, they learned that she had been listening to several health food gurus. Among the experts: Viktoras Kulvinskas.
Kulvinskas's appearance in Finn's diary doesn't surprise him.
"I'm in the diary of so many people who overcome cancer, asthma and diabetes," he said. "My compassion reaches out to her that she took the path. Well, at least she got detoxified and clean, and moved on into another incarnation."
Living With Orthorexia
Kulvinskas says orthorexics are emotionally unstable people to begin with, people like Johnny Righini and Charlotte Andersen, who have prior histories with other eating disorders. He says they take sound dietary teachings and twist them to unhealthy extremes.
"Last time I weighed myself I was about 78 pounds," Righini said. "I am 26 years old, and I was told my bones are equivalent to someone 85 years old. That's pretty depressing."
But Righini remains locked in the grip of his orthorexic eating.
"Why would I want to stop? Why would I want to eat that stuff and kill myself even faster?" he said. "That's what my orthorexic mind says. How can I stop?"
With psychotherapy, Charlotte Andersen was able to stop. Now she says her obsession with pure food was destroying her health.
"I was trying so hard to control how I was going to die, and in the end nobody gets to pick how they die," she said. "We only get to pick how we live, and I wasn't living."