When I was 19, I got sick. A few weeks into an interminable summer spent puzzling over baffling symptoms and going back and forth to doctors, my bloodwork was flagged for a possible cause — a food sensitivity issue that might just clear up with some dietary changes. It wasn't a serious health crisis. It wasn't anything I couldn't handle. But I was a teenage girl in America, so I already had a fraught relationship with food and my body. Naturally, then, I took this new information as a challenge to restrict my Diet Coke and celery sticks lifestyle even more sharply. A few weeks later, I returned to school with nearly twenty pounds carved off my already slim frame. And it took me the next several years to unlearn the self-sabotaging habits I picked up that summer.
Decades later, the combination of dietary issues and disordered eating patterns is still a perversive challenge for many of us. How could it not be? Monitoring what you eat, being mindful that your food could actually hurt you, is stressful. For people already struggling around food and body image, it can make tough mealtimes even tougher. And for people with previously untroubled eating habits — like children — those allergies and intolerances might just nudge along some brand new emotional problems.
In June, a research review published in the Journal of Allergy & Clinical Immunology: In Practice found that "Eating disorders appear prevalent in individuals with FA [food allergies]." The survey's lead author, Murdoch Children's Research Institute PhD scholar Daniela Ciciulla, further found "Higher rates of EDs [eating disorders] have been reported among those with chronic illnesses, particularly those requiring strict dietary adherence such as type 1 diabetes mellitus, celiac disease, cystic fibrosis, and Crohn disease." Two years ago, a review published the Journal of Affective Disorders Reports similarly noted "a potential association between FA and distorted body image and disordered eating."
It's a double whammy problem that patients and healthcare providers alike need to be on the lookout for as a mutually fueling fire. "Disordered eating combined with a co-occurring medical condition is a complicated mix," says Rui Tanimura, MS, RD, CYT, a registered dietitian at the virtual eating disorder treatment company Equip. "Disordered eating behaviors can cause significant disruptions to the digestive function. Oftentimes, health professionals treating people with food sensitivities and disordered eating try to understand if it was the chicken or the egg."
The National Eating Disorders Association estimates that up to "30 million Americans struggle with eating disorders, such as anorexia, bulimia, and binge eating." Simultaneously, we are living in an increasingly food sensitive age. Allergies, in both children and adults, are on the rise, although the exact causes for the uptick are uncertain. Common culprits include shellfish, nuts, milk and eggs. Roughly ten percent of us — that's about 26 million Americans — currently have at least one allergy. But that number pales next to the population living with diabetes — about 37 million people, with the CDC predicting a "surge" in that number in the next few years. Meanwhile, autoimmune issues like celiac disease are also steadily rising, affecting roughly 1 in every 133 Americans. In other words, a whole lot of us have to be careful to avoid certain foods that can make us sick — and then we have to recognize that our caution can veer into unhealthy thoughts and patterns. After all, a medical dietary issue can be a real gift to someone with a tendency toward disordered eating, a credible excuse to obsess over food intake, and to abstain when everyone else is digging in.
So what can those of us whose relationship with food can already be problematic do to sidestep disordered habits? Leah Graves, Vice President of Nutrition and Culinary Services for the eating disorder organizations Veritas Collaborative and The Emily Program, says that the first step is acknowledging that there may be potential problems. "When a medical need requires modification with food selection, those vulnerable to disordered eating are at risk," she says, "and a diagnosis of food allergy or intolerance is no exception. For individuals with disordered eating, managing both the allergy and the eating disorder together is essential." After that, it's important to build a team that's in communication with each other.
If a person is already dealing with a disorder or potential disorder, Graves says, "Close collaboration between the eating disorder care team (therapist, dietitian, psychiatrist, primary medical provider) and the allergy care team is necessary to ensure that care plans consider the needs of individuals with all diagnoses, while staying alert for any signs of worsening eating disorder thoughts and behaviors." She adds, "It is ideal to include a registered dietitian on the allergy team who is informed in both allergy and eating disorder care, as they can help individuals adapt eating patterns as necessary for allergy management while monitoring for and addressing signs and symptoms of disordered eating."
It's also important to have a strong support system, and to let the people in our lives know what's really going on. Isaac Robertson, co-founder and chief editor at Total Shape, says, "Educating friends, family, and colleagues about food allergies and intolerances can help create a sense of empathy and inclusivity. By encouraging open conversations and providing accurate information, we can reduce the stigma and misconceptions surrounding these conditions, thereby easing the burden on individuals struggling with them."
It also helps to take a few cues from existing eating disorder treatment practices and apply them to those dietary limitations. Cherie Miller, MS, LPC-S, a Dallas-Fort Worth area eating disorder psychotherapist, notes, "Intuitive eating principles are about attuning to our body's cues about what, when, and how much to eat instead of depending on external food rules to guide our eating. Having an allergy or sensitivity to a food will typically lead to unpleasant issues in your body if you eat that food, so it can be helpful to think of not eating that food as a form of self-care. I've worked with clients on seeing it less as, 'I can't eat this food' and more, 'I could eat this food, but I choose not to because I want to care for myself and my body.'"
Managing those "unpleasant issues" can be hard, and the temptation to just avoid food altogether can be immense. But doing so can exacerbate not just the psychological but the physical challenges. "When someone is restricting their food intake, they are already throwing off one's hunger and fullness cues," explains Rui Tanimura. "So as a result, tolerating more food becomes even more difficult. Someone who isn't fueling adequately with a wide variety of nutrients is negatively impacting the strength and function of the digestive system."
We don't have to spend our lives stressed out about what's on our plates, and we definitely don't have to go it alone. There are millions of us in the ever expanding pool of people who have food related health issues, and millions of others — often overlapping with them — who grapple with disordered eating. Fortunately, the challenges of one of those issues do not automatically have to worsen another. Dr. Kelvin Fernandez, a a physician and healthcare educator with Ace Med Boards, offers an encouraging example. "I had a patient who was already dealing with anorexia when she found out she had a gluten intolerance," he recalls. "We worked hand in hand, not just with the new dietary changes she needed to make but also with giving her the emotional backup she needed. Much of our work was helping her see this new issue not as a punishment, but as a tool to help her get healthier and feel better."
I still get anxious about the ways in which the things I eat might play havoc with my health. I also still sometimes find myself harboring some messed up thoughts about food and my body and the relationship between the two. I'm still working on it all. But most days, I'm okay. I know how to steer clear of the things that make me sick, and what do you know? There's still plenty of food to go around. Just because I can't eat everything, it doesn't mean I can't eat anything.
