Medically necessary diets and intuitive eating.
I originally had this post tacked on to my last post, but decided to separate them. Let’s get right into it!
For some people with certain health conditions (IBS and autoimmune diseases are a couple that come to mind), there are times when following an evidenced-based eating plan does make sense. However, for those who have struggled with restrictive eating or binging (which is typically a side effect of restrictive eating) an eating plan with any level of food restriction isn’t something you can just jump right into. Here’s why I think that doesn’t work…
A few months ago I went to a presentation my friend and mentor Nikki gave where she brought up Ellyn Satter’s Heirarchy of Food Needs. Similar to Maslow’s Hierarchy of Needs, in general, needs on the bottom of the hierarchy need to be satisfied before one can achieve the level above it. Here’s Satter’s Food Needs Hierarchy:
You can read more about Satter’s Hierachy here, but what I want to highlight is that many food interventions given by medical professionals (doctors, physician assistants, dietitians) jump right to instrumental food, when all patients don’t have the skills to be able to follow a medical diet, especially if they live in a diet mentality. To pull in an extreme example from Maslow’s Hierarchy, that’d be like asking someone without shelter and clothing to be relaxed enough to be curious about their personal potential.
Satter talks about instrumental food below:
Some people don’t have complicated pasts with food. They can become gluten free, dairy free, sugar free, FODMAP followers, Wahls follwers, etc. without becoming rigid with their eating and their mental and physical health suffering. But if you’re reading this blog that likely isn’t you. You eliminating food wouldn’t be healthy or wise to do unless you have worked on your relationship with food and it is medically necessary for you to follow a diet that involves avoiding certain foods. And when I say diet here I mean a researched eating plan that has been shown to improve the quality of life for people with particular disease states, not an eating plan that’s sole purpose is weight loss.
Part of the complicated, messy part of being a non-diet dietitian is understanding that for some people eating certain foods does lead to stomachaches, IBS symptoms, autoimmune responses, or other side effects that may be able to be managed with food, but changing one’s food without properly equipping the client with healthy eating behaviors could lead to the client being worse off. If someone is engaging in eating disorder behaviors (i.e. irregular intake, hiding and sneaking food, bingeing, no awareness of hunger and fullness cues, etc.) that part of them needs to be healed before one implements a restrictive nutrition intervention.
Something else I want to briefly mention is….if eating a certain thing doesn’t make you feel good but you continue to give yourself access to it anyways, I believe allowing yourself to have access to that food (and getting the unpleasant side effects) might be an important part of your healing process –part of you working up the Hierarchy of Food Needs– but it’d be best to work with an RD who understands your specific disease state and intuitive eating. I think there is a lot of room for intuitive eating and medical nutrition interventions (aka diets) to be melded together to help clients move up the hierarchy and eat in a way that is nourishing to them. No matter what the disease state, intuitive eating has a place and as my practice continues to grow I know I’m going to want to get clinical supervision from dietitians in different fields to figure out how to support current or former disordered eaters who also have a disease that could benefit from some nutrition intervention.
However, not all people need a medical intervention (aka a diet) to achieve a high level of health. I want to be clear that I am not saying here that the end goal for an intuitive eater should be going on a diet of some sort. I am only saying that for some intuitive eating opens up the ability to follow a medically necessary diet for a disease state they have and allows them to not engage in extreme behaviors (preoccupation with food, bingeing, etc.) as a result of following that diet. Diets are medical interventions that have side effects and before a diet is prescribed it should be considered if someone is mentally healthy enough to follow it.
Lastly, if you have an eating disorder what is necessary to heal that needs to come before any food restriction.
What do you think about this? I’d love to hear from RDs and non-RDs! Have you seen Satter’s Hierarchy of Food Needs before?
If you are an intuitive eater who has to avoid certain foods for health reasons, what’s your experience with that? What did I leave out of this post that I should’ve included?