What About Medically Necessary Diets?
This post was previously published in my newsletter, Food Psych Weekly. Sign up to get more like this in your inbox each week, and check out my new Rethinking Wellness newsletter, too!
Welcome back to Food Psych Weekly! Every week in this newsletter, I answer your questions about intuitive eating, Health At Every Size, disordered-eating recovery, and other anti-diet topics.
This week’s question is from a reader named Hannah, who writes:
I’ve been reading more and more about HAES and intuitive eating, but so far nothing I’ve seen covers this: Is it possible for people with metabolic illnesses like diabetes or polycystic ovarian syndrome (PCOS) or gastrointestinal conditions like irritable bowel syndrome (IBS) to eat intuitively? How can intuitive eating coexist with medical food restrictions?
Thanks for this great question, Hannah, and before I answer, just my standard disclaimer:
These answers are for informational and educational purposes only, aren’t a substitute for individual medical or mental health advice, and don’t constitute a provider-patient relationship.
This is a really common question, and the short answer is yes, it’s definitely possible for people with all kinds of medical conditions to practice intuitive eating. It just might look different in some ways than it would for people without those conditions.
Before we get into that, though, I think it’s extremely important with any chronic illness to separate the myths about food from the facts, because there are a number of supposedly “medically necessary” food restrictions that actually aren’t—and when you’re avoiding foods without a real medical necessity, it can vastly complicate your ability to learn intuitive eating and heal from disordered eating.
For example, there’s a type of food-intolerance test called IgG testing that certain alternative-health providers often use on people with IBS and other digestive disorders. In an IgG test, the lab analyzes your blood for immunoglobulin-G antibodies to food and spits out a long list of foods that you’re supposedly intolerant to. I say supposedly because the test is bogus—it’s not a scientifically validated test, meaning that it doesn’t detect food sensitivities as it claims to do, but instead likely indicates exposure and tolerance to particular foods. (This lack of validity is why IgG tests generally aren’t covered by insurance).
The same is true of many other spurious tests, including hair testing, cell testing, and muscle testing, whose results are no better at predicting food sensitivities than chance. As I wrote in my first book, Anti-Diet, you’d be better off asking a Magic 8 Ball whether you’re sensitive to particular foods than you would be taking these tests, because at least the 8 Ball wouldn’t charge you hundreds of dollars out of pocket.
If you’ve gotten one of those tests and started to feel like you actually do have reactions to the foods it told you to avoid, then it’s worth exploring whether you might be experiencing something called the nocebo effect, which is where you expect to feel worse when you eat something, and so you do. It’s the opposite of the placebo effect, which is where you expect to feel better when you ingest a particular food or medication, and so you do. (I talked about the nocebo effect with Alan Levinovitz in episode 94 of Food Psych, which is a good reference if you want to hear more about this idea.) This doesn’t mean “it’s all in your head”—in fact, quite the opposite. The nocebo and placebo effects are testaments to the power of the mind-body connection, and to the fact that our beliefs about food can actually cause physical symptoms.
All that being said, of course there are also real digestive conditions that do require some menu modification. If you have, say, celiac disease that’s been diagnosed by a validated scientific test—which usually means the testing was done by a licensed medical doctor or other primary-care provider, such as a nurse practitioner—you will likely feel better when you don’t eat gluten, since celiac disease is a genetic disorder in which your body can’t process gluten. (It affects less than 1 percent of the population.) And that’s where intuitive eating can come into play: You can start to develop awareness of your body and how you feel, in conjunction with your knowledge of having an accurate diagnosis, to help you intuitively choose foods that feel good in your body without having to label anything as “bad” or “off-limits.”
For IBS (which I happen to have), there isn’t good evidence pointing to particular foods as universal triggers—one person’s trigger can be another person’s favorite symptom-free snack, and vice versa. Often IBS isn’t so much about what you eat as how. Disordered eating is a major trigger, as are stress and changes in routine that can make you go too long without eating. Practicing intuitive eating with IBS can help you heal from any disordered behaviors—even subtle ones—and learn to nourish yourself consistently (although of course that’s a lot more challenging if you’re living with food insecurity).
Tuning into your body can also help you avoid going on diets for IBS. There’s one particular elimination diet that often gets recommended for IBS, and I’ve unfortunately seen people stay on it for months even though it’s really only intended for short-term use—and either way, it can be a huge trigger for disordered eating. Granted, as a short-term intervention it has shown some efficacy—but you know what else is equally effective, according to science? Stress reduction, specifically yoga and gut-directed hypnotherapy. In my view, stress-reduction practices and disordered-eating recovery should be the first-line treatments for IBS—and eliminating foods should be WAY far down the list because of the inherent risks.
Eliminating foods also generally isn’t necessary when it comes to conditions like diabetes and PCOS. You don’t have to avoid carbohydrates entirely in order to manage your blood sugar (despite what diet culture will tell you)—and it’s really not good for you to cut them out, because carbs are essential for brain function. An inadequate supply of them can leave you feeling tired, foggy-headed, and hangry. You might just need to learn how carbs work in your particular body, and how to work with them. Again, that’s where intuitive eating comes into play. With diabetes, that might mean tuning in to how you feel when you’re hungry, full, and in between, and monitoring your blood sugar to see how it relates to those physical sensations. Once you’ve started to learn your body’s signs, you can use them to help you recognize which food combinations and eating times help you feel satisfied and energized, and which ones make you feel low-energy or send your blood sugar out of whack.
A huge caveat to all of this: figuring out how certain foods make you feel is actually a very advanced move in intuitive eating, because it’s hard to disentangle what’s coming from diet culture and what’s actually coming from how the foods are sitting with you. Early in the intuitive-eating process (not to mention in the process of eating-disorder recovery), it’s hard not to conflate “avoiding foods because of how they make you feel” with *avoiding them because you’ve labeled them as bad.* Guilt about eating a particular food can actually cause physical pain.
If you suspect that’s going on for you, and if you have reliable access to food, you might try experimenting with giving yourself full, unconditional permission to eat the foods that diet culture (including Wellness-Diet culture) has told you are bad. Try to do this without judgment, and observe how you feel. If any symptoms come up, you can investigate the role that your anxiety about the food might be playing—is it making you hyper-scrutinize your digestion for any sign of discomfort? Are you experiencing that classic pit-of-the-stomach manifestation of anxiety that’s making it hard to eat?
It can be a delicate balance between listening to your body and making sure the diet-culture voice in your head isn’t creating symptoms that wouldn’t otherwise be there. Give yourself as much time, space, and support as possible to figure it all out.
Thanks again for this question, Hannah, and I hope this helps you (and anyone else who was wondering) start to think through the possibilities of practicing intuitive eating with various different conditions.
Submit your own question for an upcoming edition of the newsletter right here.
On the Pod
In episode 201 of Food Psych (2019), psychotherapist and fellow certified intuitive eating counselor Devinia Noel joined me to discuss how her work as a therapist influenced her own process of re-learning intuitive eating, why using food as a coping skill isn’t a bad thing, how diet culture creates shame, the need for diversity among intuitive-eating counselors, and so much more.
Plus, I answered a listener question about what to do if you get a diagnosis of pre-diabetes—a label with a lot of diet-culture misinformation around it.
Check it out right here, and be sure to subscribe to the pod so that you get weekly reposts of fan-favorite episodes while we’re on hiatus, and new episodes once we return.
Thanks for reading! This newsletter is made possible by subscribers like you. To show your support, you can forward it to someone who’d like it, make a one-time or recurring donation, buy my book, or join one of my courses.
Here’s to getting rid of food guilt,
Christy