Eating should not make you feel guilty.

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.

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{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…