It’s super common for me to work with individuals with digestive issues. Some may just have a bit of reflux, gas, pain or bloating they find uncomfortable and annoying, while others come with diagnosed Irritable Bowel Syndrome (IBS) or some sort of inflammatory bowel disorder like Celiac Disease, Crohn’s or Ulcerative Colitis. Because of the clientele I typically work with, the majority come knowing they have some (or a lot) of disordered eating behaviors as well.
In order to give my clients the best care possible, I need to help them understand the association between what they eat and how they feel (digestive issues or otherwise). However, I also want you to be aware of the line between where effective nutrition interventions end and where food anxiety, preoccupation and unnecessary restrictions begin. “Healing the gut” is a very popular trend right now, and while I’m not saying it isn’t an appropriate goal for some, it can also be a slippery slope into disordered eating for others. There are SO many diets that are geared toward improving digestive function, and it’s easy to jump from one to another when one doesn’t work, or isn’t as effective as you hope.
Nutrition is HIGHLY individualized and it’s not realistic to expect that a certain list of dietary rules will apply to everyone. I find that too many people feel they have to be PERFECT following the diet rules (GAPS, SCD, Paleo, etc) in order to heal, since that’s the premise behind the diets’ theories. If you buy into that, when you don’t follow the diet perfectly you not only experience guilt and frustration, but also paralyzing fear that you will never heal. You become dependent on the diet and all it’s faulty promises like an abusive boyfriend (or girlfriend) which you are too afraid to leave.
In addition, disordered eating behaviors themselves can cause digestive issues. It’s super easy to blame the food rather than your beliefs and behaviors around the food. I can totally attest to how easy it is to be blinded by the idea that your physical symptoms are caused by a lack of discipline with food, or inability to perfectly avoid dairy, sugar, gluten, grains or any number of new dietary villains. Instead, it’s very likely that the restriction/chaos cycle, under eating/overeating, lack of variety, balance and moderation are really the culprits. At what point does nutrition information/rules cause psychosomatic symptoms? I think it’s earlier than many realize.
Given that your digestive rhythm and regularity is largely influenced by your eating rhythm and regularity, if you’re eating habits are haphazard, digestion can become haphazard too. In fact, when eating patterns are unreliable, digestion tends to slow down so as to suck every last bit of nutrition it can out of whatever food it will get. Malnourishment can cause digestive adaptations which means you will probably have to push through some discomfort before your digestion normalizes in response to regular, consistent, adequate and balanced meals/snacks.
I would like to encourage you to base your food choices on YOUR experience with food rather than a list of rules that may or may not apply to you. Overall food patterns can support wellness, without being overly concerned with one food or food ingredient. In addition, feeling better is likely a result of the presence of something rather than the absence of something else. For example, let’s say you feel better eating less sugar. Could it be that you are replacing some packaged, processed foods with more fresh foods? It’s likely that eating more fresh foods is leading to improvements in how you feel, rather than not eating sugar (the point being that sugar can ABSOLUTELY still be included as part of an overall nutrient dense food pattern without effecting you adversely).
Obviously there are some who will benefit from dietary modifications, especially those with diagnosed digestive illnesses. However, I think that those are in the minority while those with symptoms related to disordered eating are in the majority. If you are in the latter, I strongly encourage you to work with a dietitian who can help you identify malnourishment (which can happen at ANY weight), challenge food rules, decrease anxiety (a huge trigger for digestive symptoms) and build more adequate and peaceful food patterns.
I was one of those with major digestive symptoms which I blamed on “inflammation”, “inflammatory foods” and “food sensitivities”. What I found was that making peace with food was the best thing I would do for my digestive function. The more regularly and consistently I ate, the better things got. As I added greater and greater variety and balance, things got even better. INCLUDING sugar, dairy, gluten, meat, grains, etc (among other things) was my solution, not my problem. You may find it’s your’s too.
Emily Fonnesbeck RD, CD
Emily, I am glad you visited this topic. What are your thoughts on having long-standing IBS (since childhood) but then developing an eating disorder and later recovering–and still experiencing IBS. Years after recovery I became increasingly symptomatic with bloating, pain, extremely bad gas (hello embarrassing) to where I felt like I needed to hide away from people because I didn’t want to have gas around them. I decided to try the low FODMAP diet for IBS and have found it dramatically improved symptoms. Thoughts in light of the topic?
Hi Megan – that’s a great question and I’ll do my best to answer generally not knowing much about you. There is no doubt that targeted dietary interventions can be helpful for those who struggle with IBS. It’s best to do that under the supervision of a nutrition professional, especially if there’s any disordered eating concerns. Also, stress and anxiety contribute greatly to digestive symptoms, and certain temperaments are more likely to develop digestive symptoms – the same types that are more likely to develop eating disorders. There are just so many moving parts so it’s probably best to approach digestive health from a mental and physical standpoint.
Thanks for the reply. I agree that unfortunately stress and anxiety contribute greatly to symptoms of IBS and tend to be coupled with developing EDs. That certainly has been the case for me. I have been careful to balance the mental and physical for the best balance I can find. 🙂 Bringing these issues to light helps us work through our own problems and also the problems our patient/clients have.
Hi Emily, I just wanted to thank you so much for your blog and especially this post! I stumbled upon it after searching online for help when I was really struggling with the restrictions of the SCD diet and had only been doing it for 3 weeks. I was on Humira for over a year and a half and it put me in remission, but then it induced a terrible case of psoriasis on my scalp and I had to stop. Instead of going onto another drug I researched other options and committed to the SCD diet with the support of my doctor and a nutritionist. After having had Crohn’s disease since 2008 I had heard of the diet before but wasn’t sure I could manage the restrictions and meal prep with my two young children. To make a long story short, after starting the diet I had diarrhea every day (prior to starting I didn’t have any!) and I was miserable. I kept telling myself just stick with it longer, but by the 3rd week I was so exhausted and started developing unhealthy attitudes to food, like just not eating because it was too much work and also feeling really depressed. This post was the first time I heard that nutrition is so individualized and a set of rules (like SCD) might not apply to everyone. Also when I read about the line where "effective nutrition interventions end and food anxiety, preoccupation and unnecessary restrictions begin" I realized I had crossed that line and it gave me the permission to stop without beating myself up. While I’ve never struggled with an eating disorder, I want to have a healthy relationship with food. The past 3 weeks I was spending hours being preoccupied with grocery shopping, meal planning, cooking and cleaning up. I was anxious and social events, paranoid about eating something "illegal." It took over my life and was starting to effect my family. Also since I was in remission prior to starting the diet maybe I was unnecessarily restricting foods that I didn’t need to? I still plan to maintain a healthy balance and variety of food, and I learned some fun new recipes, but I feel so much better physically and mentally now that I stopped. So thank you if you read this far, and truly thank you for the work you do because it was such a breath of fresh air compared to the rigid advice from so many hardcor SCD-ers. I’m happy the diet can work for them, but I can confidently say it’s not healthy for me.
Laura! YES! This is exactly what I hoped this blogpost would help people do – find a healthy balance between supporting their physical and mental well being. I relate so well to your story and I’m so glad I had a small part in helping you feel more peaceful in your situation. I am so sure you are on the right track. Thank you so much for commenting – you made my day. xxx
Hi Emily!
I just wanted to say thank you so much for this post and for being one of the only voices I’ve heard that says listen to your body rather than insert any diet/food rule/restriction here
Your blog is always a friendly reminder to listen to my body, regardless of who likes it or not- because we only get one!
I’m so glad this helped you, Natalie! I love your thoughts – recommit to listening to YOU!
Hi Emily-
How funny- I posted a status today on Facebook asking for experiences with elimination diets and anti inflammatory diets for food sensitivities after a doctor told me I would feel better if I eliminated "basically everything" and ate literally 5-6 foods for 90 days. It’s so frustrating because I want to trust my doctor …you know? Thanks again for putting an intelligent perspective on things (:
Shayne
Hi Shayne – I’m glad this was timely and you found it helpful! I do believe those elimination diets are a slippery slope, especially to those with a history of disordered eating.
Hi Emily-
How funny- I posted a status today on Facebook asking for experiences with elimination diets and anti inflammatory diets for food sensitivities after a doctor told me I would feel better if I eliminated "basically everything" and ate literally 5-6 foods for 90 days. It’s so frustrating because I want to trust my doctor …you know? Thanks again for putting an intelligent perspective on things (:
Shayne
Hi Shayne – I’m glad this was timely and you found it helpful! I do believe those elimination diets are a slippery slope, especially to those with a history of disordered eating.