Help! I am trying to practise intuitive eating but have been advised to avoid certain foods due to intolerances.

13th March, 2017

Over my 13+ years as a dietitian, my practice has forked into two clear areas of practice, food intolerance and non-diet approach (intuitive eating).

Food intolerance investigation involves periods of eliminating various foods, followed by food challenges in order to determine symptom triggers. The exception to this is Coeliac disease, where gluten needs to be avoided lifelong. I will talk about Coeliac disease separately.

Intuitive eating involves learning how to let go of food restriction and ultimately give yourself unconditional permission to eat whatever you feel like with attunement to appetite and other bodily sensations.

The two may look antithetical, but they’re not and they can even work to help each other out. The more attuned you are to bodily sensations, a key aspect of intuitive eating, the more easily you may recognise if a food agrees with you or not. The more easily you can recognise a food reaction, the easier it can be to choose not to eat that food, or too much of that food. But to arrive at this point, you need to have a sound relationship with food.

What does a sound relationship with food look like? Food is more or less just food, you eat for the most part because you’re hungry, you eat food you enjoy and that leaves you feeling satisfied and you generally stop eating when you’re comfortably full. For some, food and eating offers joy and pleasure beyond fuel or nutrition, and for others it may be more a source of fuel or nutrition. There are times you eat simply for the taste, times you eat more than you need and times you choose to eat something you know might not sit so well. There is no right or wrong, no moral imperative and no need to compensate or make excuses. If you choose not to eat something, you are doing this out of self-care, not because you shouldn’t eat the food based on diet rules.

If you suspect you may have food intolerance, or perhaps you have been advised to try an elimination diet such as a low FODMAP diet, low food chemical diet or gluten free diet (not for diagnosed Coeliac), and your relationship with food is not sound, there are a few things you need to consider.

First up, seek help from a dietitian experienced with food intolerance and the non-diet/intuitive eating approach. There are a few crucial steps that must be considered before you start eliminating food, one of these is to rule out Coeliac disease. Depending on your age and family history, you may also need to be checked for other medical conditions that may be responsible for a change in gastrointestinal (GI), or other symptoms. A thorough assessment should also be carried out to see if food intolerance is indeed likely to be an issue and not some other factor, such as disordered eating, a current or past eating disorder or other psychological issue. If you have experienced psychological trauma at some time, or are highly anxious or stressed, this can trigger GI disturbances and other food intolerance related symptoms. If your pattern of eating is chaotic, you over-eat or binge at times, or you feel emotional distress with food, then this can be a trigger for GI symptoms independent of food intolerance. Sorting these issues out first may mean food is no longer, or much less of, a symptom trigger. I have seen this many times.

A note on FODMAPs

In Australia, while the low FODMAP diet is a very effective form of managing GI symptoms, it is massively overused. This is partly due to the availability and misunderstanding of the breath testing and partly as FODMAPs were discovered here and the medical and dietetics professions have been educated in their existence and application. The breath tests available for FODMAPs are NOT a diagnosis, however, this is often not explained well to the general population. I have seen literally hundreds of people who thought their positive breath tests were a diagnosis for FODMAP intolerance. Regardless of your test results – and you do not actually need to undergo testing – you need to trial the low FODMAP diet. If your symptoms do settle, you then need to go through a process of food challenges to identify which, if any, FODMAPs are triggering your gut symptoms. The long-term aim is to free up your diet as much as possible whilst still managing symptoms; staying strictly low FODMAP long-term is unnecessary and not advisable.

Let’s assume you do have food intolerance, where a certain amount of a food in your diet triggers GI (or other) symptoms. If your relationship with food is a little dicey and this results in over-eating or anxiety around food, knowing which foods are an issue for you is not guaranteed protection against you over-eating those foods. In fact, you may find yourself craving the very food you’re trying to restrict and then over-eating it, which not only triggers symptoms, but also heightens your overall level of anxiety, further exacerbating symptoms. In this not uncommon scenario, eliminating food to try and identify food intolerance is often counterproductive and can worsen physical symptoms and psychological health. If this sounds like you, you would be better off to focus on improving your relationship with food before you start a food intolerance investigation. This is the approach I take in my practice with such clients. Once you are feeling more relaxed and neutral around food, eliminating or restricting food becomes less of a problem and any investigation you do will be more effective. You may also find that once you’re feeling more relaxed around food and no longer over-eating or bingeing on any one food, that your GI symptoms settle right down and you no longer need to do an elimination diet. This of course will not be the case for everyone, and some people will still need to investigate food intolerance and limit or avoid certain foods to manage symptoms. In my 13+ years of practice, I have seen many clients for whom this is true, but I have also seen many clients who found they did not need to restrict food once they healed their relationship with food and learned to eat intuitively.

For my clients who do need to manage food intolerances, understanding the principles of intuitive eating is of great help. Once you’re well attuned to your internal cues of hunger, fullness and how food leaves you feeling, the decision of whether or not to eat something that may trigger symptoms becomes less distressing. You may decide to eat a food with the knowledge you’ll get symptoms, but the decision is wholly yours and based on knowledge of how you’ll feel afterward. At times you may decide it’s worth it to enjoy the food or the social situation. Or you may choose not to eat the food, even though you enjoy the taste, because you know eating that food will leave you feeling unwell and therefore you’re not actually going to enjoy the experience of eating that food no matter how good it tastes. In this case, choosing not to eat something is in the name of self-care, not deprivation or restriction based on diet rules.

But what if I do this and I’m still battling the food police?

The food police is the voice in your head that says things like “don’t eat that” or “you’re not allowed to eat that.” This voice arises from diet rules where certain food is seen as fattening or “bad” based on rigid “health” ideas or weight control. If you feel you’re still battling the food police with your choice not to eat something due to food intolerance, you might like to change the dialogue. When the voice says, “you’re not allowed to eat that”, you could practice replacing that thought with “I can eat that if I really want to, but how will I feel afterwards?” You might allow yourself to eat the food in question a number of times to give yourself permission to enjoy the food and assess how it does leave you feeling. Even if the food does leave you feeling uncomfortable, the choice is still yours as to whether you truly want to eat it or not.

But I have Coeliac disease and have been told I must avoid the food completely…

If you have Coeliac disease, management does involve life-long avoidance of gluten. Again, if you choose not to eat a gluten containing food, this is based on self-care and not a diet rule. I have had a few clients with Coeliac who due to their troubled relationship with food would still find themselves eating gluten at times. In these instances, healing my client’s relationship with food and body was a vital step in reaching a point where they chose not to eat gluten based on self-care. While they were working through this, they gave themselves permission to eat gluten if they really wanted to. As their dietitian, I fully supported their choice and allowed them to come to their own decision when they were ready. For those of you reading this and thinking “but you can’t let them eat gluten”; remember, they already knew they needed to avoid gluten for a serious medical condition, initially this knowledge wasn’t enough to do so. In some cases, re-emphasising the need to avoid gluten at a time where a person is feeling “out of control” around food, would only be counterproductive. As clinicians, we must meet our patients where they are at for best outcomes for long-term self-care.

A note on food allergy

If you have a true food allergy with anaphylaxis or anaphylactoid reactions, then hopefully the potentially life threatening nature of your allergy is enough that you choose to avoid the food in question out of pure self-care (i.e. staying alive). I don’t work with food allergy as such – I have clients with food allergy but they manage it without my help – therefore, if you have true food allergy and you feel this hinders your ability to eat intuitively, please feel free to leave a comment on Facebook.

Final word

Eating intuitively is all about eating in a way that is in tune with your body’s internal regulation of appetite and how food leaves you feeling in the moment and longer-term. For some people this may involve limiting or avoiding particular food due to GI issues, headache/migraine, energy levels, skin rashes, respiratory issues or mood disturbances. Your decision of whether to eat or not eat a food is a decision you make because it’s what feels right for you. Remember, as an adult, you are the expert of your body and the ultimately the only person who knows what’s best for you.