When Food Sensitivities are Eating Disorders in Disguise

Food Sensitity or Eating Disorder?

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 sensitivities 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 your 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 immediate danger.

Food Allergies

are a different response than sensitivities and intolerances.
Food Allergies are diagnosed by a doctor specializing in allergy and asthma. They can be 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.

It is important to note is that food allergies can be outgrown in some cases and can be reevaluated by an allergist.

Celiac Disease is an autoimmune disease.

Celiac Disease is 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 is 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 sensitivities or food allergies?

A: I had to think about this one. It can be tricky to separate food sensitivities from an eating disorder since they both include a restricted diet. Exploring motivation with your treatment team is essential.

For example, a client’s sudden switch to vegetarianism or veganism can be a red flag for an eating disorder. I am NOT saying that all vegetarians have eating disorders. However, suddenly adopting a vegetarian or vegan diet can be a way to restrict foods without anyone ‘catching on’.

I’ve found that food sensitivities can be similar. If a client has an eating disorder, they may be using food sensitivity to further restrict their diet. This may not even be a conscious decision! But one that I’ve seen in practice.

So, yes, food sensitive patients do practice a level of diet restriction. However, for those clients that are food sensitive without an eating disorder, the motivation behind restricting certain foods comes from the perspective of wanting to care for and heal their bodies.

Restriction that is rooted in disordered eating is motivated by weight, body shape, self-worth, or even punishment– not by kindness to their body.

Q: What are some warning signs that an individual may have an eating disorder rather than food sensitivities?

A: Here are some warning signs of an eating disorder. If a 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.

• 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 cannot be contributed solely to a food sensitivity but to the need of weight restoration.

• Is restricting all foods in a food group.

Eating Disorder with Food Sensitivities

A food sensitivity is 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. This balance is needed in your diet in order to feel well. When you are not getting enough to eat you will feel crappy and therefore we cannot tell what is a result of under eating or of a food sensitivity.

• Is 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 reactive foods that the patient is sensitive 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.

ALSO:

Eating disorder or food sensitivities?

What is you or your loved one’s 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 may not be 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.

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 like some of my eating disorder clients.

Food has been attacked for “doing them wrong”, and it creates 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 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 additional help in figuring out if you are struggling with  Food Sensitivities or Eating Disorders, reach out to our team of eating disorder and digestive/food sensitivity experts.

For anyone listening who may be struggling with digestive issues, feel free to reach out to me directly at dana@rbitzer.com or call our office at 301-474-2499 to set up an appointment.

-Blog reviewed and updated by Rebecca Bitzer MS RD LD September 10, 2021