Navigating the Gray in Eating Disorder Recovery When You Have a Food Intolerance
Tiffany Haug, MS, RDN, EDOC
I honestly hate talking (or writing) about this topic, because I hate being in a vulnerable place where I may receive backlash from people I respect.
So, welcome, reader---to a post written by an author who hates writing about the topic she’s about to tell you about.
Let me give you some context.
As an eating disorder dietitian, it is literally a core belief of my soul that no food is bad. I think that labeling foods as “good foods” and “bad foods” perpetuates food shame, feeds into culturally disordered language and positions towards foods and nutrition, and ultimately robs millions of humans from the opportunity to enjoy food intuitively in a way that is free from unfounded food morality.
This doesn't mean, however, that some bodies don’t respond well to some foods. For example, the classic example of an individual who has a food allergy such as Celiac disease. This individual may not view gluten as bad, and may wish to incorporate foods that contain gluten into their diet with every fiber of their being, but when they do, they face the effects of damaged gut villi, malabsorption, and in most cases, GI upset (ahem, explosive diarrhea). We accept that these individuals have an allergy to gluten, and we honor that, for them, food freedom cannot include having foods containing gluten, for the sake of their health.
However, at least in the eating disorder recovery community, things get really, really, really opinionated and sticky when it comes to non allergic reactions to food, that the medical community cannot quite yet explain. An example of this, is when an individual claims a food intolerance rather than an allergy. Why is this a sticky topic you might ask? Well---for so many reasons. Because claiming a food intolerance can be completely valid, or it can many times be a cover for a disordered behavior or psychosomatic reaction that occurs in response to an individual consuming a food they believe is a ‘bad’ or an ‘unhealthy’ ’food. I always believe my clients when they tell me they are intolerant to a food. What is always yet to be determined is whether the experience of the intolerance to the food is for the most part physical, or if it is instead a psychosomatic reaction to the given food based on the individual’s belief about the food being a ‘bad food’.
I have worked with many clients who once believed they were intolerant to gluten or “refined sugar” but over time, they were able to explore, both in and out of sessions, how this perceived intolerance reaction that the body had was a byproduct of the following, such as: 1) prior lack of variety in diet which limited gut microbiome diversity, thus causing GI upset when foods not often had were eaten, 2) anxiety related to a food perceived as being a “bad food” which led to anxiety induced GI upset symptoms, 3) eating the given food rapidly due to anxiety of what it may do to the body, just to get it over with, or 4) a plain and simple fabricated story the eating disorder would cause a client to tell others to have a socially acceptable way of avoiding said food.
So far, you are probably thinking “Uhhh, this isn't too tricky, seems pretty straightforward to me.” However, the trickiness with this topic comes, when as an eating disorder clinician, you know that a given food causes a physical reaction to your own body, but continue to eat that food nonetheless, because 1) you like that food and don’t want to exclude it and 2) you want your clients to have the freedom to enjoy that food and your heart’s desire is to support them in normalizing the consumption of this food.
The reality is that I have had very, very severe eczema ever since I was a baby. Before I started dating my current fiance, I had first dates that I would go on where the dude would look down at my ankles and see my severe eczema, and their whole countenance would change. It’s pretty noticeable. It’s never been something I have been super insecure about because I figure that if anyone has a problem with it--well--that they are the ones who have a problem. Ha. But it is something that gets markedly more severe and spreads, when I include certain components of milk products into my dietary intake. This can lead to it flaring up to the point where it gets hot and itchy and it's super unpleasant. All that to say that sometimes it’s worth it to me to choose--say--a dairy free ice cream instead to prevent an eczema spreading situation. But then again, sometimes I am out with friends, or I am with a client who has worked up the courage to try ice cream for the first time since the beginning of their eating disorder recovery, and in those instances I just go for it, and if the eczema flares, then so be it, because those experiences are worth it to me.
All this to say, that if you have an intolerance or a difficult physical reaction to a given food (I’m not referring to food allergies), know that it is possible to approach this with the lens of food freedom, but that there must be nuance. Resist the urge to wear the intolerance to said food as a piece of your identity. Know that physical health is only one aspect of health, and that it does not mean that you have forsaken your health if you are intolerant to a certain food but decide to enjoy it in some instances anyway because the experience of having the food in that particular moment is worth it to you and gives you joy. Food freedom is still possible, but like with most things in life, it lives in the gray spaces of nuance.
Tiffany Haug, MS, RDN, EDOC is Master's level Dietitian in San Diego who specializes in helping individuals with Eating Disorders make peace with food and their bodies. Tiffany knows that working through recovery can be incredibly hard. Being herself recovered for almost a decade, she is incredibly honored to now be able to give back by supporting her clients along this challenging, but so-very-worth-it journey. In addition to being an Outpatient Eating Disorder Dietitian at a group practice dedicated to exclusively treating eating disorders, Tiffany serves as the Education Chair for the International Association of Eating Disorder Professionals (IAEDP) San Diego Chapter and also works as a Dietitian at Center for Discovery in Del Mar, CA. Learn more about Tiffany here.