Therapeutic Diets

An open letter to social media influencers and bloggers

To all who’ve found a diet or a way of eating that has “saved your life” and want to tell the world. 

I’m going to write to you as a professional, a psychotherapist, who specializes in eating disorders and trauma, who works daily with humans who are struggling to make peace with food and their bodies, and I’m going to write to you as a human who had an eating disorder for over a decade of my life (and has now been in recovery for more than 12 years), and as a human who lives with a chronic illness. 

First, if you are someone who has found a diet or a way of eating that has helped you to heal an ailment or to feel better living in your body, especially if you’re someone like me who has really struggled with your health, I am truly happy for you.  I know how hard it is to be sick- it can be miserable, scary & make you feel desperate for answers.  I get it and do not fault anyone for seeking to feel better or doing what they need to feel better.  I believe it’s really important for all of us to find what works for us.  I am a firm believer that you are the expert on you & your body.  Your body- you decide. 

AND I have a lot of concerns when those who’ve found a way of eating that has worked for them begin to promote it to others without sharing the very real risks inherent in doing so!  This is dangerous & harmful.  That’s a bold statement & many may disagree but I hope you’ll read on a let me explain. 

Diets, dietary changes, “lifestyle changes,” (whatever term you wish to use) are NOT a “no risk” option.  When we ask someone to change the way in which they relate to food, we are prescribing what I believe should be viewed as a medical intervention with potentially life-altering implications.   

Regardless of the reason- if it’s for weight loss or to address a health condition- making changes to a person’s diet, the way they relate to food, is a big deal and should not be done without thorough consideration of the costs & benefits.  Just as I believe surgery is sometimes necessary, I am not against all dietary changes.  There are reasons why dietary changes are necessary or worth considering (allergies, Celiacs, Chron’s, etc), AND I believe we should always be discussing the costs and risks. 

Note: This blog is going to focus specifically on the dangers of dietary changes focused upon health concerns, and I recognize discussions of weight and health are often deeply intertwined.  I understand and will never judge someone for the desire to lose weight- our society conflates weight/size with health & beauty and has made thin an ideal.  And the evidence is quite decisive that weight loss diets are neither effective nor health-promoting (for more- article by Linda Bacon and Lucy Aphramor)

So- what is the risk of dietary changes?  First and foremost, there is the risk of developing an eating disorder or disordered eating.  The number one risk factor for the development of an eating disorder is dieting.  I know many will argue that dietary changes for health are not “diets”- I hear the distinction, and the reality is that when you begin to mess with someone’s diet, or their relationship to food, the risk of developing anxiety and preoccupation around food increases.  I see it everyday. 

Orthorexia is an eating disorder that develops when someone becomes fixated on “healthy eating,” to the point that it consumes their mental space and causes lots of anxiety around food. It may not have anything to do with weight or body size (it may be mixed in there but not necessarily).  Orthorexia can destroy someone’s life, and we need to be aware that many who may be following dietitians, health & wellness coaches or bloggers, may be especially at risk, so caution is needed. 

There are also costs beyond eating disorders or disordered eating.  The diets most commonly recommended for those with health conditions, sometimes also referred to as “therapeutic diets,” (elimination diets, anti-inflammatory, etc) usually require a person to purchase and prepare very specific foods.  It often requires an investment of finances & time.  That may be okay, even worth it for some, but it needs to be a consideration & discussion.

If we are truly concerned about health- as in the overall wellbeing of a person- we also need to ask about what a person might be sacrificing in order to follow this diet, especially if what they are sacrificing has health-promoting benefits.  For instance- maybe the increased expense means greater financial stress to pay their bills, or maybe to stay adherent to their diet plan, they’ll begin to avoid social gatherings with food, skip invitations to eat out with friends.  Following a strict diet that requires increased stress (financial, emotional) or social isolation can be detrimental to someone’s health.    

Maybe now the best thing I can do now is to speak personally… 

A few years ago, I became quite sick. I was facing debilitating fatigue, nausea & pain.  It was incredibly difficult and I was desperate for answers.  I saw numerous doctors & alternative medicine practitioners.  I tried prescription medication, supplements, acupuncture & herbs.  As an eating disorder therapist and someone in recovery from an eating disorder, I knew the problems with diets and I definitely knew the potential cost.  I was fairly opposed, at first, because it seemed in opposition to my values.

Here is where I’ll make a little confession- becoming so sick revealed to me that I did have some rigidity around being “non-diet”- my definition of “intuitive eating” lacked sufficient nuance, especially as I applied it to myself.  Moreover, there was fear.  Recovering from an eating disorder & learning to make peace with food and your body is not for the faint of heart.  I had done a lot of work and felt confident in my recovery.  AND I was aware that I was in an incredibly vulnerable space. Being sick is incredibly vulnerable. My body didn’t feel right and no one could tell me why.  I’d done all this work to focus less on how my body looked and to value my body for what it could do….and now my body wasn’t working.  (And therein lies another problem I discovered- there can be as much danger in valuing our body for its abilities as there can be in valuing it based upon appearance…but that’s another blog). 

I was looking for non-diet solutions yet I found little being said about how to manage a chronic illness from a non-diet approach.  Intuitive eating blogs didn’t have any tips on how to eat you are nauseous all-day every day.  The only people I could find who were speaking to experiences I was having were those who discussed ways of changing your diet. I found lots of blogs and books about how x diet or y diet had cured someone or “saved my life,” and all had assurances that there were “not diets,” just “nutrition facts” that’d help my body to heal.  To someone who is vulnerable and desperate, these words are powerful (I even knew a lot was hype…AND I was desperate). 

Without going into the details, I eventually did decide to try variations of elimination diets.  I did so with the support of a HAES, non-diet dietitian.  I did it because I was desperate and dietary changes kept being offered as a solution which eventually I felt like I needed to try.  I followed these diets for many months.  I had the financial means to order food from a food delivery company so it was expensive but not quite as time-consuming (b/c I knew myself and knew I spending the limited energy I had constantly preparing food was not going to improve my health).  I will not lie- there were some small benefits & improvements I saw while doing it.  AND it never healed me.  No matter what I ate or didn’t eat- my symptoms never fully abated. 

My elimination diets had MANY costs. It was expensive but even more it was mentally taxing.  I couldn’t just buy the foods I liked or just go to restaurant with friends without checking the menu ahead of time- I had to worry about the ingredients.  Many of the foods that had always brought me pleasure weren’t on my plan (and let’s me honest, the substitutes are rarely as satisfying).  I was having to monitor and assess my symptoms- trying to determine what food was helping or hurting.  With chronic nausea, eating already wasn’t a lot of fun much of the time….this diet took much of the remaining joy in eating away. 

As someone in recovery, I was continually checking-in with myself around my relationship to food.  I was very rooted in my recovery, had a lot of psychological & emotional resources to support me and still it was hard. I think it’s nearly impossible to have nausea nearly constantly and to not to develop some anxiety around food.  It’s hard to avoid that fear that this food will make you sick because that your fairly constant experience.  Staying neutral about food isn’t easy, and these type of elimination diets don’t make it easier.

Still I followed these diets because I had hope, I was desperate for it to help me. I really wanted an elimination diet to work, for there to be a food I could remove or a way I could eat that would make me feel better and give me back the life I’d had before.  And it didn’t, and that was also really hard. Eventually, I had to face the hard work of grieving and accepting this is the body I have (again, that’s another blog post).

At other moments in my recovery, I think all of this would have sent me spiraling back into my eating disorder. Thankfully, I had a lot of support in this process. I know myself, I’ve done my own work and worked in this field for enough years to have learned a lot.  I didn’t do it alone- I had professionals and friends supporting me, including a very compassionate and honest dietitian who helped me navigate every step.  I am okay but many will not be able to navigate these diets without harm.

I do not come to those of you who’ve found a way of eating that works for you with judgement.  I know what it’s like to seek solutions.  If you’ve found a solution- I’m glad. And my plea to you is to be wary that what worked for you could very well cause harm to another.  Many who are vulnerable get sucked into “therapeutic diets” and instead of improving their health, they now find themselves battling an eating disorder. 

Please, please, please- especially those of you with large platforms (bloggers, social media influencers):

Please consider the influence you may have over others as you “share your story and offer what worked for you” 

Please speak to the potential costs associated with a diets (or dietary change)

Please warn of the dangers of eating disorders and disordered eating 

Please consider NOT sharing the details of what you’re eating