By Dana Magee, RD
This week I had the privilege of joining Kathy Cortese on the ED Matters podcast titled, “When Food Sensitivities are Eating Disorders in Disguise”. This topic that is near and dear to my heart. My passion is helping others rebuild a healthy relationship with food. I find that rebuilding process is essential with both my eating disorder and food sensitivity clients. Below are the questions that Kathy and I explore together on the podcast.
Q: Can you please give us a definition of food sensitivity or food intolerance?
A: This is a question I answer daily, it is so important so I always like to start by straightening out these definitions.
Food sensitivities trigger an immune response in your body that can cause symptoms of digestive problems, headaches, joint pain, muscle pain, skin issues, and/or fatigue.
The tricky thing with food sensitivities is that they are dose dependent. This means that you may experience no symptoms with a small portion of the food. Say a few carrots in a soup. Or even a full portion of the food like ½ cup of cooked broccoli. But at a certain amount, let’s say broccoli three days in a row for dinner, you may experience symptoms .
Another aspect unique to food sensitivities is that they can be delayed response. They can occur 45 minutes to 3 days after you have the food and that before you develop symptoms. This makes the process of discovering a food sensitivity very challenging without the help of a Registered Dietitian experienced in food sensitivities.
Check out our food sensitivity testing for more information on determining your food sensitivities.
Food intolerances are when you body is not able to break down the food. With lactose intolerance, it’s not the milk that’s an issue but your ability to digest milk sugar. With this particular intolerance an option is to take a lactase enzyme pill, which supports your body in breaking down milk sugar.
It is helpful to point out that unlike food allergies- sensitivities and intolerances are not life threatening, may affect quality of life but not putting you in danger.
Food allergies are a different response than sensitivities and intolerances.
Food Allergies are diagnosed by a doctor specializing in allergy and asthma. They are life threatening. Reactions are commonly immediate, occurring within 1 hour of eating the food. They can involve anaphylaxis, immediate GI symptoms, or hives on the skin. Due to the type of reaction and rapid onset of symptoms, they are often pretty easy to diagnose. You can also be tested for food allergies by blood test and/or skin prick test. Reactions can occur with even the smallest dose so total avoidance of the food is necessary. Also important to note is that food allergies can be outgrown.
Celiac Disease- An autoimmune Disease
Celiac Disease involved another food related response important to add to this list. It is an autoimmune disease where there is a physical damage and change to the intestines. This disease can be tested for and it a completely different response that warrants completely removing wheat, rye and barley from the diet- all gluten containing foods.
Q: How is an eating disorder distinct from food sensitivity or food allergies?
A: I had to think about this one, it can be tricky to diffuse the effects of the eating disorder with the effects of food sensitivities. Exploring motivation with your treatment team is essential.
A red flag as a practitioner for an eating disorder can be sudden switch to vegetarianism. I am NOT saying that vegetarians have eating disorders. However, this is a red flag to screen for disordered eating as it can be a way to restrict foods under the radar from your diet without anyone catching on. Food sensitivities can be similar. The eating disorder can use the sensitivities as ways to further restrict their diet. This may not even be a conscious decision!
So , yes, food sensitive patients do have a level of restriction. However, the motivation behind it comes from a compassionate place where they are caring for their body and how these foods make them feel. Disordered eating typically comes from a place that is motivated by weight, body shape, self worth, or even punishment, not by body kindness.
Q: What are some warning signs that an individual may have an eating disorder rather than a food sensitivity?
- If you or a loved one has lost a significant amount of weight quickly, regardless of body mass index (BMI). Drastic and sudden weight loss for a person has negative health impacts. It can cause anxiety, slowing of digestion (pain, bloating, constipation), headaches etc. Sudden weight loss is going against our bodies will to survive. Our caveman instincts see restriction as a threat to survival.
- If you or a loved one is a low weight status. The malnutrition will come with severe symptoms that are very similar to the list of food sensitivity symptoms listed in number one. I would say even a year after weight restoration symptoms can not be contributed solely to a food sensitivity but to the need of weight restoration.
3. If you or a loved one is restricting all foods in a food group.
Food sensitivities are not specific to the whole group of foods. Examples include animal proteins or starchy foods, which are often the first target for an eating disorder. Food sensitivities can be something as benign as paprika, which does not typically make it onto a feared food list when fighting an eating disorder. With food sensitivity testing we can see that there are foods from every food group that are safe for the patient . It possible to keep a balanced diet. They will need this balance in their diet in order to feel well. When they are not getting enough to eat they will feel crappy and therefore we cannot tell what is a result of under eating or of a food sensitivity.
4. What is your or your loved ones motivation for changing their diet? Is it coming from a place of caring for your/their body? Intuitive eating is using the information our body gives us in order to nourish ourselves. Eating a food that makes us feel unwell is not in line with intuitive eating. This is easier said than done because the “Ed” voice can often get muddled into these thoughts. Diet mentality and judgement can produce mental distress.
5. Are you or a loved one cutting out foods until there is nothing left?
I use food sensitivity testing and from that testing we can create an elimination protocol. This is NEVER long term. Even foods that the patient is sensitive to will eventually get added back into their diet. The goal is to heal the gut and be able to get back to the most variety possible. Number one is getting enough to eat so if the restrictions are too stringent I always speed up how quickly we liberalize the diet.
Check out Dana’s podcast interview.Q: Knowing how complex eating disorders are, what a some of the challenges in recovery for a person with food sensitivities and an eating disorder?
A: This is so complex! I truly believe that my digestive clients have similar food fears and negative food relationships as my eating disorder clients.
Food has been attacked for “doing them wrong”, and it’s a strained relationship. There is a lot of crossover with gut issues and eating disorders. I can’t help but wonder is it the chicken or the egg? Is it this negative experience with food that made you feel unwell contributing to the struggles with food and the inability to trust your body with food in your eating disorder? Or is is the effect of the eating disorder behaviors on your gut flora and gut motility that is now affecting your digestion?
If you are struggling with an eating disorder and suspect food sensitivities may be involved step number one is to assemble a treatment team. A physician, therapist, dietitian and psychiatrist, and digestive doc if needed. Eating disorders are complex illnesses. They take time to treat. Seeing a dietitian that is experienced in food sensitivities and eating disorders is important. Anytime there is intense focus on your eating there is a potential for dipping into disordered eating. Working with sensitivities can be very triggering. Having an RD that understands eating disorder treatment is key and can help you untangle the Ed thoughts and the symptoms you are having.
A dietitian experienced with eating disorders will be helpful in monitoring risks for developing an eating disorder. For example, a family history of eating disorders, eating behaviors, substance abuse, OCD/anxiety, and belief systems around food is very important to keep in mind. Keeping food in its place is important to your overall health.
For everyone listening who may be struggling with digestive issues, feel free to reach out to me directly at firstname.lastname@example.org or calling our office at 301-806-0556 to set up an appointment.