I hope you ponder over today’s post. Marinate it in your mind. And if you struggle with food related fears or guilt, begin to make a change for yourself.
When eating leads to debilitating pain or a potential anaphylaxis reaction, fear can seep into food choices. I get that. When eating food leads to guilt and anxiety driven by self imposed restrictive food rules with no real health benefit or the fear consumes your everyday life, that worries me. In today’s food culture, there are more ‘rules’ associated with healthy eating and an increase of fear mongering related to food in the media. If you experience guilt with eating, blame your diet on the onset of your health condition, or find food choices occupy the majority of your daily thoughts, it might be time to ask for help from your health care provider.
Embrace food related joy.
I am a big picture type of thinker. I often think about the fact that we are just a little dot floating on a ball in a big galaxy. Our time is limited on the planet, Earth, and as far as I am concerned, I want to enjoy the ride. 😉 Feeling anxious and guilty everyday around food sounds like a kill joy to me. Do you agree? What I hope you entertain during this post is the impact of food choices on your quality of life. If modifying your diet has allowed for less pain and enhancement of your daily enjoyment, then you are on to something good. But, OVER restricting the diet unnecessarily will very likely lower your quality of life, lead to potential social isolation, and perhaps place you at risk for malnutrition. You many find modifying your diet keeps your symptoms at bay. But, what I want you to think about is, are your restricting more foods than necessary to keep your GI distress in check?
Define your goals. If your goal is to be pain free from GI distress, then work with your health care provider for guidance in managing your diet as least restrictively as possible gain to control of your symptoms. If modifying FODMAPs manages your symptoms, why would you then remove all low FODMAP grains from your diet? Why would only eat raw foods or only cooked foods if you didn’t notice any benefit? Why would you remove every grain of sugar from your diet if you enjoy a brownie as a treat every now and again? I see this all the time. Again, I am not defining what diet you should follow but rather posing the question, are you restricting more in your diet than necessary? And why?
Marci Evans, Food and Body Image Healer, MS, CEDRD, LDN in Boston notes, “While some dietary modifications might impact your social life, we want to keep those to an absolute minimum. Managing your digestive health is about creating a fuller life, not a smaller or more limited one.” I love this quote.
{Photo from the my trip to Japan 2015–the peaceful, Bamboo Forest.}
Food: Friend or Foe.
I have been in the food and wellness field for over 25 years and have seen the food culture change. Not all for the bad. We certainly have a better sense of the role of good nutrition in health and disease. We understand how diet might impact IBS symptoms. Scientific advances for a better quality of life…it is a good thing. But then there is this undercurrent via the media, social channels such as Instagram, Facebook and other networks that has created a food culture of food villains (gluten) and foods with a health halo (bone broth and coconut oil). Terms like ‘clean eating’ , detoxing, and black and white food rules add to our growing unhealthy obsessed and rule based food culture. Deviating from all the often unfounded rules can lead to unnecessary guilt and shame. Who can really admit they like bone broth for breakfast? And yet, I have patients arrive at my office with this eating pattern quite frequently.
Bad feelings of deprivation. Bad feelings of guilt. It’s all bad. You deserve more.
You might find this dialogue unexpected from a dietitian that specializes in an elimination diet. And while I do myself experience food sensitivities, I feel strongly that these food sensitivities do not define me. Some individuals have to modify their diet to maintain a pain free existence. I certainly understand that. And, I help patients identify their food triggers with the goal to help them enjoy the most liberal diet they can enjoy without pain or debilitating symptoms. My concern is when food becomes an unnecessary enemy driving unfounded fear. The inducer of guilt. Every bite is over-thought and over-analyzed. Pseudo-science and sensational media posts in part drive the fear. We need to realize when our food choices have been driven by the media and not by science!
When you suffer with food sensitivities along with gut symptoms, the effort to feel better often puts great pressure on individuals to make the ‘right’ food choices. The notion of eating food for enjoyment and pleasure is being replaced by fears, guilt, and sometimes even, self loathing. For those with GI distress, this environment gets even more muddled, as efforts to change diet to end the debilitating pain of chronic disease can add another layer of burden.
The blame game.
After a major intestinal resection, I experienced an interesting and somewhat sad paradigm. When my abdominal pain would flare likely due to the scar tissue I had developed, the question was often posed to me, “Oh, what did you eat?”. This may seem like a normal question to you. Perhaps you hear this everyday. But, doesn’t this question in part suggest your choices created the pain? Do these types of blame question start the cascade of eating related guilt? Fortunately, for me, I recognized how this question made me feel and was able provide a response that helped defuse that type of questioning in future interactions.
But here is the truth, diet is not always the culprit. Menstrual cycle related hormone changes, gastrointestinal secretions, altered motility patterns of the gut which can be driven by our microbiota and stress, are just a few other potential causes of GI symptoms.
The brain and gut are interconnected.
Marci Evans, describes the gut-brain connection, “Given the fact that digestive health challenges and diseases significantly negatively impact quality of life, it’s exciting that nutrition can play a positive role in helping people feel better. But often, the focus becomes on what to take out of the diet and requires a degree of vigilance, research, and pre-occupation that can easily become unhealthy. One of the newer eating disorder related terms out there is orthorexia nervosa (ON). It’s not an official eating disorder diagnosis. But the central feature of ON is that healthy eating is taken to such an extreme that it becomes unhealthy either physically, mentally, or emotionally. And those suffering from digestive health problems are at a real risk for their healthy eating to become problematic.” IBS is a condition where gut-brain dysfunction is part of the diagnosis.
Controlling your diet may give you a sense of control, but really, is it?
Marci relates her experience with eating disorders and the overlap with GI distress, “Interestingly, there is overlap between what makes someone vulnerable to a functional gut disorder and what makes someone vulnerable to an eating disorder and it has a lot to do with personality, temperament, and overall mental health. So if you are someone who is naturally anxious, kind of perfectionistic, and struggling with a functional gut disorder, I would encourage you to very careful about how you approach your digestive health. You will need to take extra care to make sure the changes you make in your diet don’t stand in as a surrogate for feeling in control of your life, better than those around you, or a greater sense of self-esteem. And definitely consider talking to your health care provider if you feel you are tempted to eliminate more foods than what is recommended, follow an elimination protocol for longer than is intended, or begin to feel a greater fear of disease or guilt as you make changes to your diet.”
Role of health care providers
If you are a health care provider that works with patients, it is important to ask questions about food related guilt and fear. Patients need support and guidance in this area. Offering the patient supportive services such as a dietitian, therapist, or even clinical hypnotherapy can be helpful to support the patient with food related guilt or over restriction.
Dr. William Chey, Gastroenterologist, at University of Michigan. notes, “The recognition and acceptance of diet as an important treatment represents a watershed moment in history of managing IBS patients. Though interventions like the low FODMAP diet can effectively reduce symptoms in half of IBS sufferers, some patients with hyper vigilance and high levels of food fear can overdo dietary elimination. It is critically important for providers to recognize such patients, who are said to suffer with orthorexia. These patients typically identify an excessive number of food intolerances, are very resistant to diversifying their diet, lose weight, and can develop nutritional deficiencies. These patients often require coordinated, multidisciplinary care from a physician, registered dietician and mental health provider.”
Marci sums it up nicely, “I want for my clients to feel a greater sense of peace with food, not an increasing sense of fear.”
Would love to hear your thoughts…
Megan King
Kate, as someone who can appreciate all of this from both a professional and personal standpoint, I truly appreciate the post! I spend a lot of time in my practice helping people un-learn the unnecessary food rules they have created for themselves. One part of the modified FODMAP diet I like is that patients are allowed to eat anything! It boils down to choice and it is OK to choose a high fodmap food if that is what they are wanting/having to eat in a particular moment. It is not necessary to be perfect.
The most difficult part of this is the fact that people with anxiety tend to have functional gut disorders and also tend to really want to be able to control everything about their conditions. They are looking so desperately for something to work. Would a major component to treatment be to decrease overall anxiety levels? Would this help to lessen symptoms?
katescarlata
Yes, I think working on hyper vigilance and anxiety can be helpful. Trying not to be perfect or attain unreasonable goals.
Iris
Hi Kate – thank you for the thought provoking post. I am curious about your opinion of certain food sensitivity tests like Cyrex and others. I had that test done about a year and a half ago and it indicated that nearly everything green, everything that is a grain plus eggs, dairy and countless other staples of life are things I should avoid either due to immune reaction or gluten cross reaction. I have been able to add some of the ‘problem foods’ but very few. I am wondering mostly if these tests are meant to be an evaluation of a “point in time” or if these are meant to be life long restrictions.
I have since been diagnosed with mitochondrial dysfunction which can be the root of a very leaky gut, SIBO, chronic GERD, (All things I have had going on over time). I am on a GI steroid presently, which paired with diet choices, keeps at least the heartburn, rashes and joint pain at bay. I feel that some of my continuing issues might stem from a lack of variety in my diet. I try and add some foods in here and there and as you know, symptoms are hard to tie to a certain food. I keep a diary and am vigilant about my food choices (see above article for Type A personality) but still some things continue to cause problems. I haven’t found anyone in my area that can help with the diet side of things. What are your thoughts? Thanks in advance, I am a long time reader. I tried a FODMAP diet while at the height of my leaky gut, so now FODMAPS are a staple in my diet at present and I am sure some still cause symptoms. Am I shooting myself in the foot being overtly limited or is this just my lot in life?
katescarlata
You certainly have a complex history –so hard to provide general advice. You do need to see a dietitian that understands how to put the complexity of your health issues into a more constructive nutritional approach for you. I do worry about the role of under-nutrition on both the brain and gut–not a good long term strategy to under eat. I am not that familiar w/ Cyrex—but find that food sensitivity tests have very little scientific data to back up their use. And many of these tests lead to unnecessary restricting foods based on pseudo-science.
Anne
Thanks for this post. I started a low FODMAPS diet back September, along with more recent antibiotic treatment for SIBO. While it has definitely helped my GI functioning and I have lost about 20 lbs, I have been concerned about “going too far” with this. Life is very out of control right now with family care issues and finding that I have no appetite at all so forcing myself to eat…but easier right now to stay on the stricter beginning diet than reintroducing foods in a controlled way. Was definitely showing signs of dehydration too last week so backed off a bit on trying to be so perfect about low FODMAP foods only. Of course, that raises concerns about eating problem foods for SIBO, but there’s a limit to how much I can focus on at once!
Will be talking about this post with my GI doc next week. Thanks much.
Lorraine Matthews-Antosiewicz
Hey Kate. I’ve been having my own digestive issue lately – heartburn :/ My ‘gut’ was telling me right from the beginning that it was NOT what I was eating and yet that is the question that kept coming up from the GI doc (and myself at times). What could I be eating that is causing this discomfort? As a result, I changed what I was eating, cut back on amounts; I lost weight and started feeling scared to eat certain foods. Well, come to find out that I have a small sliding hiatal hernia and a sensitive esophagus. The discomfort can come on (randomly) any time of day or night totally unrelated to eating. I think – and maybe the doc believes me – that certain sudden movements (like getting up and down) or air, gas, pressure in my stomach can cause the hiatal hernia to move – and I feel it. It has caused some mild irritation and I feel that too. Maybe there is some connection to food, but I don’t think so. As you say in your blog, food is not the culprit.
Thanks for the thoughtful informative blog!
katescarlata
Thanks for sharing your story, Lorraine.
Sally Wessely
Kate, I posted the following response on a private site for folks like me whom suffer from scarring alopecia. Your article is brilliant and important. Thank you for writing it Here is my comment I shared:
After following the writings of Kate Scarlata for several years, I find this piece of writing essential reading for almost all of us because either we ourselves or someone in our circle of friends and family struggles with eating issues. As sufferers of scarring alopecia, I think we naturally begin to blame what we eat on our condition. I don’t think the medical field has enough information on diet and scarring alopecia to definitively say that diet will effect change in our hair loss one way or the other. Hair loss, IBS, and my other issues is a true conundrum or me. I suspect I am not alone. Certainly, a poor diet benefits no one. I struggle with many GI issues and IBS as well as FFA/LPP. I don’t think I’ve read anything in a long time that resonates with me more than this article. Her advice is brilliant. I hope you will take the time to read the words of this informed, well educated, and informative dietician. She might just change your life.
katescarlata
Thanks Sally, your comment means the world to me. Thanks for sharing my post and I am glad it resonated with you.
Barbara
Wow! What a wonderful post. As an organic farmer with a 50 year history of IBS and many friends who are into raw food, wheat grass juice, high fibre etc I have spent way too many years guilt tripping and making my symptoms worse by trying to follow their advice, even though I noticed that if I ate in a restaurant i.e. “not healthy”, I had fewer symptoms. I got to the point that I had so much IBS-D that I dropped to 90 lbs and was probably malnourished. Thankfully I was referred to a nutritionist by my family doctor who put me onto the FODMAP diet. The diarrhoea stopped overnight on the elimination diet. The other symptoms are under control and I now allow myself to eat foods that I would have avoided in order to eat super healthy. I realize that one can overdo on the “healthy eating”, Your post is a must for all of us that have spent so long trying to eat “healthy” even though it was making us sick.
There is no one size fits all. Thank you so much. I look forward to your post each week.
katescarlata
Hi Barbara, thanks for your comment! I am so happy that you look forward to my blog each week! Put a big smile on my face! But, I am even happier that you have found relief w/ the low FODMAP diet–and that you have learned that we are all different–what works for someone else–might not work for us.
Julie Lenti Danielson
This post from Kate has my name written all over it!…and I am sure so many others!
Yes, I too suffer from IBS and other intestinal issues…. and sometimes to be painfully honest, I let them take over my life.
I thank God every day that I found Kate from one of my former students who studied under her.
Sometimes I look at food as “the enemy”, and that is NOT GOOD! :(((
However, when you have suffered severe pain, anxiety and some clueless GI doctors, the anxiety level soars.
I printed out your article Kate, and will read it religiously! I mean more than once… and daily if need be!
Right now, thankfully I have a wonderful GI doctor and you , Kate, to help me as I continually help myself. Thank you so very much for taking the time to address the psychological part of IBS and other gut problems. Life is to be lived, food enjoyed and joy in living.
It was very good to sit back and absorb this post from you in my mind.
Thanks a million for your care , compassion and unbelievable knowledge.
You are a blessing!…to SO MANY!
katescarlata
Oh Julie…you gave me chills. YOU are a blessing to me..so thank you. I have been extremely fortunate to have the best clients and followers in the land. And yes, per your words: “Life is to be lived, food enjoyed and joy in living.” Amen to that!
Anne B
I really appreciated this article Kate. As a person who sells fresh fruits and vegetables I sometimes run into customers who are too worried about what they eat and whether it is safe. Reassurances about good farming practices seem to fall on deaf ears and they continue the anxiety riddled relationship with their food. I like your caring balanced approach to encouraging the release of guilt and eating sensibly while listening to our advisors and our bodies.
katescarlata
Love those words, Anne, ‘eating sensibly’. that is right on!!
Maria
Wow, thanks so much for this post! I’ve definitely struggled with disordered eating in the past in an attempt to control my life. Finding the low fodmap diet was one of the things that helped me overcome my unhealthy relationship with food, and I’ve often wondered if there’s a connection between IBS and eating disorders. Eating always made me feel bloated + miserable and not eating felt so much better, even though I knew it was harming me in other ways. I still struggle with wanting to control my diet, but the line of thought in the fodmap diet – that nothing is “bad” and to figure out what works for you – has been really helpful. So great to see a dietician addressing this subject!
Joyce @ The Hungry Caterpillar
Thanks for sharing these very wise and encouraging thoughts, Kate. I can tell this is something you’ve thought a lot about. Part of my journey with IBS includes anorexia–in fact, sometimes it’s a little bit difficult for me to tell which caused the other. I was restricting food in part because of how awful and bloated I felt every time I ate, but on the other hand, I often wonder if restricting food and eating so little actually only made my GI symptoms worse. I totally know what you’re saying about reactions to flare-ups automatically being: “What did I eat?” as opposed to something more neutral that doesn’t lead to that feeling of guilt. I’ve found that following a modified low-FODMAP diet does increase my quality of life, but it’s also concerning to me, as someone who has survived a very severe eating disorder, to see people on even more extreme elimination diets (low-FODMAP is extreme enough!) It’s sad that a lot of these diets are considered “healthy” when in truth, most dietitians would not even support them. Thanks again for your thoughts.