People suffering from eating disorders (ED) often complain of digestive distress such as bloating, constipation and abdominal pain. In one study 98% of female ED patients met the criteria for at least one Functional Gastrointestinal Disorder (FGIDs). Out of those patients 52% of were diagnosed with IBS, 24% with constipation, 31% with abdominal bloating and 51% with heartburn. Another study looked to see if IBS came before or after an eating disorder, although the majority of participants developed IBS afterwards, approximately 12% developed IBS before or at the same time as an ED.
What has yet to be determined is does IBS generate hyper-vigilance and obsession about food as a way to alleviate symptoms. Does someone with a digestive disorder strive to feel better by trying various new diets, or become fixated on a specific “clean diet’ and thus develop an “unhealthy obsession” with healthy eating?
A preoccupation with eating the “perfect” diet is called orthorexia. This term was coined by Dr. Steven Bratman and he says:
“Healthy diet turns into orthorexia when a boundary is crossed and a person’s relationship with food begins to impair various essential dimensions of human life. There is no bright line to mark this transition, but it can be recognized as a situation in which the search for a healthy diet has taken on a life of its own and no longer serves the goal of improving health.”
There is a narrow divide between having a clinically diagnosed eating disorder and having disordered eating. Our culture is obsessed with dieting and it is estimated that up to 50% of the population has a disordered relationship to food and their body, but not a full blown ED.
If you feel anxious about certain food groups or take a rigid approach to eating you may be skating the line into disordered eating. Following a Low-FODMAP diet, or any therapeutic diet, may contribute to these feelings. We may become scared to eat at restaurants or at friend’s homes, worried about reintroducing higher-FODMAP foods and limiting ourselves to a short list of low-FODMAP foods in the search of healing.
In no way am I saying that we shouldn’t reach for a sensible way of eating that is nourishing and relieves our digestive distress but we must be aware that for some of us, like myself, it is easy for a healthy diet to turn into a disruptive relationship with food.
My story goes back to when I was diagnosed with IBS in high school. My symptoms were severe enough to disrupt my life and keep me from participating in normal teenage activities. I quickly made a connection with the food I ate to how I felt. I wasn’t self aware enough to understand how and which foods contributed to my pain therefore I began limiting myself to very specific foods. This was during the low fat craze so my diet consisted of bread and low fat processed items. No surprise that my symptoms became worse which led me on a dangerous path of binging, purging with exercise and finally, after becoming a registered dietitian (RD), orthorexia. Yes, I am not happy to admit it but the first 10 years practicing as an RD I restricted myself to a very limited diet. It wasn’t to lose weight but rather as a way to control my IBS symptoms which continued to disrupt my 20’s and 30’s. Looking back, I realize that what was disrupting my life even more than IBS was my orthorexia ways. After researching and following the low-FODMAP diet and then subsequently reintroducing high-FODMAP foods I was able to liberalize my eating and my meals became more balanced. It seems counter-intuitive, but a low-FODMAP diet can be liberating IF done correctly and with the right intentions.
With that being said there is always a possibility that following a therapeutic diet, such as a low-FODMAP diet, may trigger disordered eating and orthorexia, even if it is only followed for a set amount of time.
If you are in the midsts of an ED please do not try a low-FODMAP diet, the priority is to seek treatment with an experienced professional.
Here are some some signs that may indicate an unhealthy relationship to food and what try:
- You are scared or worried about reintroducing high-FODMAP foods back into your diet. First, reassure yourself that this is the most important part of healing IBS symptoms, decide to look at reintroductions with curiosity and as a scientist. Have a set guide as to the exact day you are starting, for example Monday of next week and have a plan of exactly which food from which group of FODMAP’s and the amount you are going to reintroduce. Reintroductions can be confusing so it is wise to work with a dietitian but here is a great article from A Little Bit Yummy.
- You feel anxious eating outside your home and often cancel dinner plans with friends or avoid social situations where food is served. This is a hard one to make peace with because while following the initial phase of a low-FODMAP diet we do need to be strict with eating only allowed items so we can give our digestive systems a rest. BUT if this causes an excessive amount of distress you can either eliminate only one category of FODMAP at a time, for example, for 2-4 weeks only eliminate disaccharides, or dairy, but continue to eat a everything else or decide to take a relaxed and joyful approach to socializing. This means if you are dining out and eat a high-FODMAP food that disagrees with you take note, move on and return to a low-FODMAP diet at your next meal. This won’t “mess” up your phase one, it only means you may need to stay in phase one a bit longer but who cares? Certainly not you.
- You are following a low-FODMAP diet but still have occasional bouts of diarrhea, gas, bloating and pain, therefore you decide to eliminate more food, even items that are consider “ok”, just in case. This is a slippery slope because when we are in pain our biological drive is to reduce the pain in any way we know how. I get it, I can go there too. First, remind yourself that everyone, I repeat everyone, has bouts of diarrhea, gas and bloating, this is called being human. If your symptoms are more than occasional or occasional but bothersome consider these things:
- Maybe the low-FODMAP diet isn’t the magic bullet, and that is ok. Have you been tested for celiac disease or other digestive disorders?
- Are you eating in a rush, or mindlessly at your desk while you work?
- Are you chewing your food? Digestion begins in the mouth, not your stomach. If large chunks of food enters your small and large intestines there is more chance of it fermenting and causing problems. It is the utmost importance for people with digestive disorders to eat slowly and to chew. A meal size salad should take at least 30 minutes. In a future post I will discuss my favorite topic, savoring our meals and chewing our food.
- You are becoming overly consumed with how your gut (and body) feels and then use exercise to relieve IBS pain. People with IBS have a heightened visceral sensitivity. Basically this means, feeling more pain in the gut due to things such as food moving through the system or gas building up in the intestines. One possibility is the gut-brain connection. This means that when we are feeling stress there are changes in the nervous system that amplifies the sensation of pain. Gentle exercise can help relieve this pain but an excessive and obsessive amount can quickly become disordered. Before turning to more exercise try more relaxation. Take several deep breathes throughout the day and when you are feeling gut pain don’t name it, just feel it and watch it with curiosity, breathe with it, invite it in. If you exercise, and I do recommend moving the body on a regular basis, set healthy limits and choose activities that are enjoyable. Try walking or yoga or stretching or barre class, whatever makes your body feel good but don’t do it as a way to punish the pain or for that matter, burn calories.
Let’s commit to having a gentle approach to healing gut disorders, one where we are kind to ourselves, where we honor our hunger and how our bodies feel, and where we trust that when we eat delicious food, low-FODMAP or otherwise, we will effortlessly digest and assimilate what we need.
If you are interested in learning more about taking a gentle approach to nutrition here are several RD’s who are doing fabulous work in the field.