It feels a little blasphemous writing this as a Registered Dietitian Nutritionist, whose days are centered around helping clients explore their relationships with food and ease their ability to eat, and eat well, with attention to both satisfaction and nutrient/energy needs. But as I continue to work with clients who suffer from co-occurring eating disorders/disordered eating and gastrointestinal symptoms and disease (both diagnosed and undiagnosed), it falls upon me to hold space to consider that, rather than specific foods causing the issues, it is often underlying structural, chemical, and neurological conditions (or all 3!) that give rise to symptoms, symptoms for which food plays a mere supporting cast member role.

Let’s take an example like SIBO, or Small Intestinal Bacterial Overgrowth, a condition where bacteria that typically live in the large intestine migrate to the small intestine and cause bloating, distention, gas, abdominal pain, and a host of other symptoms unique from client to client. When someone suffering from SIBO eats, their symptoms generally get significantly worse, leading some to believe that the food itself is causing the distress and then eliminating food categories and volume as a result. However, once SIBO is accurately diagnosed and treated (including the underlying cause), most people can return to eating food without pain or complication.

So while it’s vital to acknowledge the reality that eating and eating certain foods can increase physical pain in the body (see the post When Food Hurts), it’s equally important to distinguish between the food being the cause of that pain and the underlying conditions that are the real culprits. Otherwise, we risk demonizing a large swath of foods unnecessarily, creating a risky scenario for disordered eating, nutritional and energy deficiencies, psychological distress, and increased difficulty re-introducing foods once the underlying condition is treated and better controlled or healed. And equally important, if we do need to limit certain foods to minimize pain and distress while the underlying condition is being evaluated and treated, the gold standard is always going to be finding alternative sources of energy, rather than simply eliminating foods, to keep the body and brain as functional as possible and minimize complications down the road.

Similarly, one of the golden rules of feeding during clinical nutrition training in a hospital setting, as I had so many years ago, is this: If the gut works, use it! This held true for some of the sickest patients we saw. Parental nutrition, or feeding intravenously, was only used as a very last resort because once we stop passing food through the gut, it becomes increasingly challenging to re-introduce food without significant complications and distress almost as severe as the distress that led to stopping PO feeding (food by mouth) in the first place.

Consider how this applies in a restrictive eating disorder: The less food passes through the gut, the more the body adapts to an under-active digestive system, including slower motility, fewer digestive enzymes produced, interrupted insulin secretion, and a whole host of other adaptations - a sort of “use it or lose it” scenario. Re-introducing food to a sluggish or inert digestive system that is under-resourced and functionally challenged can be a tedious, distressing, and long road. So for all these reasons, whether we are addressing an eating disorder, a digestive condition, or a combination of the two, it becomes crucial to find alternatives and substitutions for foods contributing to discomfort, rather than simply eliminating them all together.

And more importantly, the faster we can evaluate and treat the root cause of the distress (SIBO, IBS, IBD, MCAS, or a whole host of other potential conditions), the more quickly we can work to manage those conditions while maximizing the food diversity and volume to continue meeting nutrient and energy needs.

This is not to say that there are not certain underlying conditions that absolutely warrant avoidance of particular foods or food groups indefinitely (Celiac Disease and IgE food allergies come to mind), but even these conditions have a root cause beyond the food itself: Abnormal immune responses, that will likely some day in the not-to-distant-future have treatments that allow foods to be consumed without injury or threat. Even in our current GI climate, there are new enzymes that can assist with consuming foods formerly off-limits to people, those who follow a low-FODMAP diet for instance (a topic for another post!)

So let’s consider not demonizing the foods themselves, but conceptualizing the GI distress our clients face as underlying conditions that deserve thorough evaluation and treatment, of which food avoidance or adjustment may play a minimal supporting role.