Laura Schoenfeld: This, to me, sounds more like a psychosomatic effect of the food as opposed to the food actually being something that he shouldn’t be eating. I’ve seen this in some clients before, where they would have certain foods that they restrict themselves to that don’t cause symptoms, but then anytime they try something new, they feel that they have the bloating and gas and diarrhea or constipation or whatever GI symptoms that happen. I’m not saying they’re making it up. They do actually experience these symptoms. But the problem that I’ve seen in some of my clients is that a lot of times the food that they’re eating, compared to the food that causes the symptoms, there’s really no rhyme or reason to it.
Just to give you an example, I had a client with some significant GI problems that also had an eating disorder, essentially. She would tell me that all FODMAP foods and all fruits and a lot of vegetables caused her to have really bad bloating, but every couple of days she would have this sugar-free … maybe it was almond milk, some kind of almond milk or coconut milk ice cream that that was sweetened with xylitol and had a bunch of guar gum and carrageenan and all this stuff in it to help thicken it. Basically it was straight-up FODMAP ice cream. She said that she tolerated it fine and nothing about that bothered her. I don’t think she realized that it was a FODMAP, but she would say anytime she would eat a fruit that she would get bloating.
I’m not saying that she was making any of that up. My thought was that the GI symptoms in her case were definitely more psychosomatic, and that basically just means that the brain is controlling the symptoms as opposed to the food itself. If you have a ton of fear around including a food, anytime you’re super nervous or if any of you have done public speaking for the first time or done something that you were really nervous about and you had a GI response to that, that, I think, is more likely what’s happening than the food itself causing problems.
This can be really hard, especially because this client is 70 years old and he’s been having trouble since he was in his 20s. You have to think this person has a 50-year history of gut symptoms that were induced by food, so he’s probably at the point where he has a very restricted diet that he feels afraid to broaden. It sounds like it’s clearly not actually helping his symptoms at all to be on this very restricted diet, but I wouldn’t be surprised if he has some level of phobia about introducing foods back in. This can be really hard because when somebody has an ingrained fear about food that has been going on for decades, getting them to the point where they are able to reintroduce foods comfortably can take a really long time and can be very hard.
I had one client that felt that she could never tolerate any carbohydrates. Luckily she was a little bit more open minded about trying things, and she was getting really desperate and felt like she just had to start introducing foods back in. It really just took time for her body to get used to those again. She just had to keep eating things. Even if they made her uncomfortable, she just kept eating them. That’s, honestly, a way that a lot of eating disorder facilities treat their clients, even if they’re having GI symptoms from new foods. They just have them keep eating until the GI symptoms go away. It can be really hard because with most eating disorder treatments, they’re just going to have them eat anything, including wheat products and dairy and sugar and all this stuff that might make somebody feel poorly, but you do have to get this client to the point where he realizes that the reintroduction of these foods is probably going to cause symptoms but he has to do it for his long-term health’s sake.
Just from the basic information that you gave me about this client, I would say a little bit of tough love and a little bit of challenge to him, to say, “Listen, this may be something that’s being caused by your fear of food, and the food itself may not actually be the problem, and we need to start introducing new things. That way, we can get you off this super-restrictive diet because the restrictive diet is going to cause problems in the long run. It may even be causing problems right now.” Yeah, just tell him that he should actually expect symptoms and that having symptoms doesn’t mean that he’s never going to tolerate the food. It just means that he has to kind of experience those as he’s reintroducing foods. That could be helpful. Maybe just exploring why he’s afraid to add things back in, what he’s afraid will happen if he has the symptoms, what his symptoms are now and how those change if he reintroduces food. He may be getting bloating and gas and diarrhea from anything that he eats, and it may have nothing to do with the food choices that he’s making. This is definitely more of a psychological question. I don’t think there’s any special diet that’s going to help him here. This is really going to be an effort to get him to take risks with food, start eating things that even if they don’t make him feel good, just pushing through it. I mean, obviously we don’t want him to be doubled over in pain and not able to get out of bed if his gut hurts so much, but if he has some bloating and gas, that’s not that big of a deal. He’ll survive. So just kind of force the food choice expansion, that kind of thing, while he’s experiencing these mildly or even moderately uncomfortable symptoms and just getting him to the point where he’s OK with experiencing those symptoms even as he’s increasing his variety.
That’s the approach I would take. I’m not saying that’s the only approach; however, my experience with clients is that a lot of them will have reintroduction symptoms to anything that they’re eating, and all it takes is a few months of them just taking the risk of eating foods that cause symptoms and not letting the fear of the symptoms get in the way of them branching out on their diet. Hopefully that helps. That’s a really complicated issue, and you may need to think about referring out to either an eating disorder specialist or a psychotherapist that maybe specializes in picky eating or phobias or something like that, that can help with the psychosomatic portion of that because that can be really hard to deal with if you’re not trained.