The purpose of today’s post is to introduce the role of Intuitive Eating (IE) for gut health, IBS symptom management and overall well-being. I also introduce some of Rebecca Scritchfield’s messaging via her fantastic book, Body Kindness: Transform Your Health from the Inside Out–and Never Say Diet Again, as additional tools to help you create a more positive and accepting relationship with yourself, food and life’s circumstances. For this post, I interviewed, Evelyn Tribole, dietitian and co-author of the book, Intuitive Eating, A Revolutionary Program that Works ,Rebecca Scritchfield, dietitian and author of Body Kindness: Transform Your Health from the Inside Out–and Never Say Diet Again and Kathleen Meehan, dietitian and IE practitioner.
This post has been a work in progress for months now. I wanted to do some homework myself! I read Body Kindness (for the first time), Intuitive Eating (Again!) as well as, The Eating Instinct by Virginia Sole-Smith to prepare myself for this post. These books all offer a different lens of the unhealthy state of our diet culture. Intuitive Eating and Body Kindness offer great tools to help live a more balanced and healthy life. I hope you read this post with an open mind. I have really enjoyed learning more about IE and Body Kindness via my interviews with these 3 bright dietitians. Additionally, although I didn’t delve into the book, The Eating Instinct in this post, I did find it to be very thought-provoking about the dark side of diet culture. Many people with IBS experience occasional, low level food fear. This is a normal response, in my opinion, as eating food can cause pain. But, if significant food fear and strict food rules become an issue for you in your effort for IBS symptom control, this post may resonate with you. I also encourage you talk about your fears openly with your healthcare provider to get appropriate help. Here is a recap of some of the key messages threaded through my discussions and readings that I have been working on the past last several months.
Let’s start with this quote from the book, Intuitive Eating co-author, Evelyn Tribole, MS, RD, “Guilt has no place when it comes to eating.”
I think this might resonate with some of my followers. In the book, Intuitive Eating (IE) has a broad message about guilt and eating. The take-away: everyone deserves a “peaceful and satisfying relationship with food.” Amen!
Perhaps this seems daunting for those who live with food intolerance because eating some foods has brought about physical pain. But as you learn what foods work for your body and trust in trying new ones in the most gentlest of ways, I believe most of you will be able to expand your diet and enhance your relationship with food. The goal here is to become more trusting in your body (rather than the food rules you may have in your mind) while enjoying as many foods that work for your body. This might require some work on your part –to pull away from ‘food rules’ you have consciously or unconsciously created for yourself or that perhaps those rules you have been exposed to from the pseudoscience all over the Internet. I trust, that some of you already have a good relationship with food (yay!)–but certainly some of you, may benefit from additional tools.
Intuitive Eating is NOT a diet. It is a philosophy that embodies 10 key principles. If you need to also be on a medically therapeutic diet (such as a low FODMAP diet), you can still embrace the principles of IE.
In the book, Intuitive Eating -A revolutionary program that works by Evelyn Tribole MS, RD and Elyse Resch, MS, RD. The authors guide you through 10 key principles of IE:
- Principle 1: Reject the Diet Mentality
- Principle 2: Honor your Hunger
- Principle 3: Make Peace with Food
- Principle 4: Challenge the Food Police
- Principle 5: Feel your Fullness
- Principle 6: Discover the Satisfaction Factor
- Principle 7: Cope with your Emotions without Using Food
- Principle 8: Respect your Body
- Principle 9: Exercise: Feel the Difference
- Principle 10: Honor your Health: Gentle Nutrition
Some key features within the IE framework include simple and yet often dismissed messages in today’s diet culture:
- Listen to your body.
- If you’re hungry, feed yourself.
- Find what pleases your palate.
- Food should be savored, enjoyed and leave you pleasantly satiated.
With IE, you may ask yourself, “Am I comfortably full or do I need more food?” Principle 5 of IE was probably one of my bigger challenges. Growing up as the youngest of nine, I learned quickly that if I ate quickly, I might get my hands on a second portion of food. Ha! When we dined out, I would always leave the restaurant over full and literally unbutton my pants in the car on the ride home. No joke. It took me until I was nearly 35 years old to learn that I could leave a restaurant comfortably full. Yes, I needed to learn a bit about how to “use food constructively” and “feel my fullness” to better honor, Principle 5 of IE. Quite simply, I learned that taking home leftovers was a viable and much more physically pleasant solution, when my body provides the signal that it is full.
Role of Food Fear and Guilt
Every single day we are exposed to fear-based food messages. This can pose a real challenge when eating food can trigger GI symptoms. For people living with food intolerance with SIBO or IBS, trying to get a real grip on gut symptoms and get on with life …can easily lead to fretting every single mouthful. But, this, my friends is not a great way to living your best life. Evelyn Tribole notes, “When your diet becomes too rigid that it affects your quality of life, it’s time to make peace with your value system.” The stress of unnecessary diet restriction will likely keep your gut in over-drive too. A gut on over-drive will lead to GI symptoms. I hope as you read through this post you will see that self-care via nutrition is vastly different from attempting to control symptoms with diet. It may seem similar but it isn’t. Read on.
Of course, what you choose to eat is personal. Evelyn Tribole reiterates this very point during our interview together, “Only YOU are the expert of your body.” And with that, I think everyone should mind their own plate. See my post on this topic here. But, I think, it is essential to identify your intention of why you are modifying your diet or eliminating foods, and to identify when you are being too rigid.
Evelyn Tribole shares her thoughts on this topic, “Your choices should come from a desire to feel good inside your body, rather than a desire to attempt to control your body.”
When it comes to approaching nutritional therapy for IBS it is important to know that the goal of nutritional modification is for symptom relief and ultimately, to improve your overall total health and quality of life. What do I mean by total health–total health includes your body and your mind. Food choices should be good for your emotional health too. Your quality of life can take a hit if your diet is controlling every facet of your life.
When I spoke to Evelyn Tribole about the notion of guilt with eating, Evelyn told me this, “Unless you stole food from a store, guilt has no place when it comes to eating.” Feeling guilty because you ate a brownie or a high FODMAP meal out with friends, offers zero benefit. Let go of food-related guilt! And while I am discussing food guilt, as a reminder, please don’t ever shame or guilt others about there food choices! It really does not serve any positive purpose. “Guilt = unnecessary suffering’, notes Evelyn Tribole. As a reminder, you did not cause your IBS!
Take note and be careful when you read nutrition messaging online or via providers that you are working with that includes guilt tactics. Facebook groups are notorious for this. Have you seen comments, such as, “Wheat is poison. I would never eat it if I were you?” “Taking antibiotics is like an atomic bomb for your gut microbiome?” UGH!!! These are the types of social media sites that you want to break away from. If your Instagram or Facebook feed is full of fear-related food messaging, please remove these people from your feed…and your mind. With that in mind, you can find all 3 of the dietitians I interview in this post on Instagram just click on their names for link, Evelyn Tribole, Kathleen Meehan,and Rebecca Scritchfield.
How can we calm the bidirectional messages from the gut to the brain if we allow food to prompt constant fear? This may take some work–but adequate fueling and moving away from fear-based messaging (with support and guidance from your healthcare team) will lead you on your way to a better perspective and improved healing.
When you experience food intolerance, fear can find its place at your dinner table. How will this food make me feel? Will I be in pain for the next three days if I eat this food? The goal with intuitive eating and food intolerance–is to get to a place where food choices and responses to biological signals become mainly intuitive. Hopefully you are able to shut down fear mongering messages that you have read online–and look at food a bit more differently– with a new lens to determine how different foods make you feel physically as well as mentally. Each of us can adapt IE principles in a way that is individual to our own goals.
Evelyn Tribole, sums it up perfectly here, “Intuitive Eating for Gut Health –one size does not fit all”.
We must individually explore the 10 principles to learn to let go of food rules that no longer serve us, to let go of guilt, to lean into your body (mind and gut)-and let it guide you. You CAN gently learn to loosen your grip and begin to stop micro-managing food.
Honor your hunger and Enjoy Food
In the book, Intuitive Eating, Principle number 2 is “Honor your Hunger”. In this principle it is noted, “once you reach the moment of excessive hunger, all intentions of moderate, conscious eating are fleeting and irrelevant. Learning to honor this first biological signal sets the stage for rebuilding your trust with yourself and food”.
If you are not eating enough to fuel your body, your blood sugar can plummet, making you feel irritable and frustrated. And this undue stress can stimulate messages from our gut to our brain via the gut:brain axis. Under fueling may impact the motility of the intestine too, leading to an array of GI symptoms.
How can we heal our body when we are not fueling it appropriately?
Another principle in Intuitive Eating that may resonate with you is Principle number 6, “Discover the Satisfaction Factor”. How can we enhance our level of satisfaction when it comes to eating? This passage from the book, Intuitive Eating sums this concept up very well, “When you eat what you really want, in an environment that is inviting, the pleasure you derive will be a powerful force in helping you feel satisfied and content.” So… if you eat a bowl of bone broth because you heard it was food for you and you absolutely are grossed out by the taste and experience, I would suggest that perhaps you try to eat something else. Yes, you deserve to enjoy and feel satisfied with what you eat!
IE in practice
Next on my quest to learn more, I spoke with Kathleen Meehan, IE practitioner and dietitian. I asked Kathleen, do you think a low FODMAP diet can work within an IE framework? Kathleen notes, “Intuitive Eating and a low FODMAP diet can work together, but I think it’s essential to also consider the big picture.”
It’s important to note that eating disorders (EDs) are often coupled with some gastrointestinal (GI) disturbance. The altered eating behavior seen in EDs is strongly associated with disturbed GI sensitivity and GI motor physiology. While there are a number of interventions that can help alleviate some pain and GI discomfort, a low FODMAP elimination diet (or any elimination diet) would not be appropriate in individuals with a past or current history of ED.
Kathleen’s approach to diet for IBS, “I rarely do the full low FODMAP elimination diet anymore. I might encourage a person to make small changes if I notice very high FODMAP foods occurring in large quantities or with significant frequency – we might talk about adding in more variety and see if that helps to alleviate symptoms. I also might suggest low FODMAP foods if a person would enjoy eating them.”
“Long before I learned about Intuitive Eating, it’s always been important for me to encourage my clients to have the most liberalized diet possible. If a person has IBS, that means managing symptoms in other ways like, reducing stress levels, considering meal timing, finding gentle movement and practicing self compassion in response to discomfort. And if a person has cut out any foods, we usually explore how we might experiment adding them back in as time passes. We know that the gut and it’s ability to tolerate different types of foods (including FODMAPs) is not static. Especially if stress has reduced, many of my clients have been surprised at what they can tolerate.
Intuitive Eating can still be practiced even if a person requires medical nutritional therapy, such as the low FODMAP diet, and I believe that dietary changes can be helpful for some people. But I also believe it’s essential a person also work to heal their relationship to food, so the mindset is more about self care than restriction or control. If ‘lifestyle changes’ are based on rules or rigidity, those changes are not any different from an unsustainable diet. Intuitive eating allows for attuned decision making. There may be times where you nurture your body with a wide variety of low FODMAP foods. There also may be times where you give yourself permission to have a higher FODMAP food simply because you’d like to enjoy it, and avoiding it would feel like deprivation.”
Kathleen shares here thoughts on Principle 3, of IE, Making Peace with Food, “If food restriction is medically necessary (with food allergies, or celiac or in some cases with IBS), it’s entirely understandable that a person might feel deprived, and I think it’s ok to acknowledge how hard it is. Many clients need to work through a grieving process.”
Kathleen continues, “In my opinion, Principle 3 and IBS speaks to the nuance of intuitive eating and it’s important to consider intention. Intuitive Eating is about attunement, and paying attention to how your body responds to foods. I always like to approach food choices as a personal choice based on experience. Specifically with IBS, there may be some situations where you choose to eat a food you know gives you a bit of discomfort, but you choose to do so anyway. You might skip a certain food because you’ve listening to your body and you’ve had a past experience you don’t care to repeat in that moment. It’s critical to explore whether this has to do with a specific rule, or if it’s because you’ve experienced feedback that’s caused you to feel uncomfortable.“
Food is not moral! Don’t think of it as good or bad. Do you have internalized or unconscious food rules that are not serving you?
Kathleen shares more, “I also think it’s critical to make sure you haven’t developed strong rules or feelings of morality around food. For example, you might find a certain high FODMAP food causes you to feel poorly, but you don’t necessarily believe that food is bad, and conversely that low FODMAP foods are ‘good.’ You’re also not ‘bad’ if you eat a food you know might bother your IBS. If a person is experiencing guilt around their food choices I would want to explore that further.”
One of Kathleen Meehan’s favs, is Principle 4 of IE, Challenging the Food Police. “I like to consider the different ways a person talks to themselves. From my own experience with IBS, I know there are times when I have absolutely no idea why I am experiencing symptoms, and that can be frustrating. Prior to really adopting IE, I might have been a bit critical for what I did wrong. I hear this from many of my clients as well, and it often leads to black and white thinking about the need to ‘follow a perfect diet’ to avoid symptoms. These moments are a great place to practice self-compassion and acknowledge that it’s uncomfortable to feel uncomfortable, but this too will pass. Using critical language will only cause additional strife and distress. Instead, neutral, understanding and non-judgment language can help a person make peace. I think this is a skill that can go a long way and influence a lot more than IBS.”
Kathleen continues, “If someone had very strong beliefs or rigid beliefs about what was contributing to their IBS symptoms, I’d want to explore it a bit more closely. I’d also want to examine the different rules and then consider is this helpful? Because IBS is so interrelated to how we feel, it can also be helpful to pay attention to how certain thoughts affect how we feel. Sometimes, feeling anxious about a certain food or eating experience is likely to play a role in GI symptoms. This is another reason why I always like to bring in curiosity or non-judgment.”
Kathleen recaps with this important message, “I also strongly feel that if your diet is stressing you out, it’s also influencing your IBS”.
YES. YES. YES. I fully agree with this.
How can IE help keep your gut happy? Here are a few tips from Kathleen Meehan:
- Eat consistently throughout the day (don’t skip meals!)
- Honor hunger and fullness cues
- Participate in gentle movement (Yoga, nature walk)
- Choose a variety of foods
- Avoid the overeat then restrictive eating cycle
- Notice what helps you to feel well or unwell
- Add in foods that may specifically help the gut, like prebiotics and probiotics
Embracing Body Kindness
I also spoke to Body Kindness author, Rebecca Scritchfield to get her take on how her body kindness messaging and the science she explores and touches upon in her book can be embraced by those living with IBS and food intolerance. Many facets of the book, Body Kindness is geared toward individuals that want to break from the chronic dieter’s mindset. There are many tools that I believe can be helpful to an individual living with food intolerance and IBS. In the very beginning of Body Kindness, you will find this quote by Rebecca Scritchfield, “Health is not just measured physically. Emotional health is an equal part of the equation.”
Yes!! I couldn’t agree more! For those with gut disorders, the gut:brain axis, a bi-directional pathway between your gut and brain is on over-drive. Emotional health can play such an important role in symptom relief and management. Again, the key message is: If food choices are stressing you out, you most certainly are stressing your gut out too.
Rebecca goes on to say, “The secret to being well is treating yourself well and establishing healthful habits you can feel good about. Creating positive health habits should not drive a person crazy.” Amen. Amen. Amen.
In our interview, Rebecca talked about the importance of getting to the bottom of how to deal with stress. Certainly, living with a chronic illness can be stressful, Rebecca notes, ” Find coping strategies that can benefit overall health such as meditation, prayer, and yoga.” Rebecca and I spoke about “PACT”, a mindful practice, during our interview and how it could be applied in IBS. The goal of the PACT framework is to become aware of what is bothering you and become curious on how to best help yourself. Here is an example that Rebecca provided for this post:
P: Presence. What is bothering me now? Example: I am worried about my GI symptoms
A: Acceptance: Accept your feelings. Example: It’s okay to feel worried.
C: Choice: Find a workable solution. What choice option helps me create a better life? Example: I will find a dietitian to guide me on a workable nutrition plan or make an appointment with a GI psychologist, when stress feels bigger than me.
T: Take action: Make an action item related to your personal value system. Example: I want to start with working with my dietitian on eating 3 balanced meals and trying one new recipe a week.
Use this PACT model to guide you through your obstacles by creating a personalized workable solution.
Another fabulous quote from Rebecca, “Here is the beautiful truth: You do not have to go to extremes to be healthy. In fact, extremes can leave you decidedly unhealthy and unhappy.” Again, I find this messaging will resonate with some individuals that have maybe gone a bit far with their diet modifications.
The book Body Kindness embraces 3 major pillars of health: Love, Connect and Care. In short, Love: health grows from love. Connect: treat your body like a friend, let you body guide you in its choices, and Care: remind your body that your are in this together with this simple mantra, “I’m your friend, not your enemy.”
It’s a beautiful thing when you begin to treat your body like your very own best friend. It is not the enemy!
Another great quote from Rebecca, “Eating has the potential to be a trustful, intimate, connection between you and your body. But if you are stuck in a rigid framework of rules that dictate your food choices, you’re probably missing out on some meaningful opportunities to enjoy a variety of foods in healthy, guilt-free ways.”
So, there you have it, Friends. Lots of food for thought. We can all get entrenched in rules–but it is important to be open to unlearning some of them when they do not serve us. Embrace what is working too! It’s all about becoming more in tune with what truly is helping you and uncovering what may be hindering your health when it comes to your relationship with food.
This was a long post but a topic I feel it is so important especially for people that live with food intolerance as well as healthcare providers that work with individuals with digestive symptoms. The goal is to untangle and remove unnecessary food rules, learn to lean into your intention for diet modifications to gain a better understanding of the goal, identify what is working for your total health (gut and mind) and what is working against your desired health goals, and to embrace a healthier and happier life–for your gut, your mind and beyond.