Can you practice intuitive eating with a chronic disease?

There are a lot of myths about intuitive eating (she said in the understatement of the century). One of them is that you can’t learn or practice intuitive eating if you have a chronic disease that uses medical nutrition therapy (MNT) as part of your treatment plan.

You absolutely can. And if intuitive eating interests you, and if you want to both enjoy your food and do what you can to help manage your condition, then you should.

You might have diabetes, or high cholesterol, or high blood pressure, or irritable bowel syndrome (IBS), or rheumatoid arthritis, or Crohn’s disease, or colitis. You might have successfully overcome cancer and want to prevent a recurrence. But you still eat.

You still have food likes and dislikes — something that you may need to explore more fully.

You still benefit from tuning into how your food satisfies you and how it makes you feel physically. If you are an intuitive eater with a chronic diet-related health concern, this tuning in may extend to how what you eat influences your symptoms and/or the markers of your condition. Let me give you a few real-world examples

Intuitive eating and IBS

Most of my clients come to me for help with breaking up with chronic dieting, disordered eating and sucky body image, so we work a lot with intuitive eating. But I have a separate group of clients who need help navigating the low-FODMAP diet to help manage their IBS symptoms. Many of my IBS clients sought me out because I’m skilled in intuitive eating and can carefully guide them through the elimination diet in a way that doesn’t retrigger diet mindset or, in a few cases, a long-recovered-from eating disorder.

(Note: the low-FODMAP diet is not right for people who currently have, or who have only recently recovered from, an eating disorder.)

I find that intuitive eating works beautifully with the low-FODMAP diet, because while, yes, the first phase of the diet is an elimination diet, which by its very nature is restrictive, the ultimate goal is food freedom. By that, I mean the freedom of gaining clarity about which foods, in what amounts, trigger symptoms…and which foods don’t.

Often, people know that something they’re eating is causing them abdominal pain and forcing them to stay near a bathroom, but they aren’t sure what. That can create food fears that strip much of the joy from eating and may lead to eliminating more and more foods over time, even foods that were “innocent bystanders.”

By tuning in, observing and experimenting as the client and I move through the phases of the diet, they gain trust in what their body is telling them, reducing fears and expanding the variety of foods they can confidently eat. And if they discover a food they love doesn’t love them back? They can still choose to have that food at a time and place where they can be at home, near their bathroom.

Intuitive eating and blood sugar

I once knew a woman who discovered her blood sugar was quite high, but not quite high enough to signal type 2 diabetes. She wanted to keep it that way. She wasn’t practicing intuitive eating per se, but she was paying attention to how what she ate affected her blood sugar. And she was doing it from a place of curiosity, experimentation and observation, not from a place of scarcity or fear.

Much to her surprise, she found that many of the foods you’re not “supposed to” eat when you have high blood sugar did not affect HER blood sugar, but some other foods that were supposed to be “fine” did raise her blood sugar.

Because she trusted her body to tell her the truth, rather than fearfully sticking to a generic list of dietary rules, she felt confident that she could adapt her eating to any situation. And if someone commented that they were surprised she was eating a certain food, she could respond, with authority, that maybe this food wasn’t the best choice for other people with diabetes or high blood sugar, but it was a good choice for her.

The power of positive food voices

If you’ve read “Intuitive Eating,” you know about the Nutrition Informant from the “Challenge the Food Police” chapter. The Nutrition Informant is one example of a common “food voice,” and it’s one that can work for you or against you. When it’s working against you, it’s upholding diet culture by using nutrition as a tool to keep you dieting. When it’s working for you (when it’s divested from the Food Police), it becomes your Nutrition Ally, and can help you make food choices that support both health and satisfaction, without guilt or deprivation.

Another food voice is the Food Anthropologist, who can help you experiment to discover what choices are right for you and your health by observing the effects of your choices non-judgmentally, and sort through the facts neutrally rather than getting caught up in fear, guilt, shame or blame.

Curious about how the 10 Intuitive Eating Principles work with eating to manage a health condition? Here’s my take

1. Reject the Diet Mentality

Diet culture, wellness culture and healthism form a sort of unholy triad that can really get its grips into you when you’re newly dealing with a health condition, or when you get lab results indicating that you aren’t managing that condition as well as you thought you were. Because doctors and other healthcare providers tend to prescribe weight loss as a solution for, well, everything, even in the absence of robust evidence to support weight loss over things like nutrition, movement, medication, and other things that would be prescribed to a thin person with the same health condition. So learning to reject the diet mentality definitely applies!

2. Honor Your Hunger

Learning to tune into and recognize how your body expresses hunger is a valuable skill for anyone. So is gaining a better sense of what foods or combination of foods satisfy your hunger longer, and which foods leave you hungry again quickly.

3. Make Peace with Food

When breaking up with dieting, forbidden foods are generally those that allegedly lead to weight gain, or those that you feel out-of-control around because you’ve held them at arm’s length for too long.

4. Challenge the Food Police

Anyone who’s dieted has experienced their inner food police, and that can be amplified when you’re worried that if you eat certain foods — or don’t eat others — that your health will directly suffer. Challenging the food police means freeing yourself from false messages knocking around in your head about how your food choices relate to your health.

5. Discover the Satisfaction Factor

Assuming that you have a reasonable food budget, you have so many foods available to you. So even if you have a health condition that can actually be helped by avoiding or limiting certain foods (such as salt with high blood pressure and saturated fat from meat with high cholesterol), there may be some sadness. But there is still joy and satisfaction to be found in all the many foods you can still have. Also, you might find that preparing old favorites in new ways allows you to continue to enjoy them while still supporting your health.

6. Feel Your Fullness

When you trust that you can feed yourself with satisfying foods, when you’ve made peace with food and challenged your food police, it makes it easier to wrap up your meals when you are comfortably full, rather than chasing satisfaction from unsatisfying foods and ending up feeling uncomfortably full.

7. Cope With Your Emotions With Kindness

Being diagnosed with — and trying to manage — a chronic health issue can be stressful and even scary. Learning how to identify the emotions that are coming up for you, and cultivating a diverse array of coping tools for your toolbox, is good for your mental and emotional health, which in turn has benefits for your physical health.

8. Respect Your Body

Many of us have a hard time respecting our bodies in the best of times. If you feel like your body has failed you by becoming sick, you are in even more need of learning to respect your body for all the things it does for you.

9. Movement—Feel the Difference

Physical activity is good for our general health, and it can play a specific role in managing many health issues. If you’re scared, it’s easy to run headlong into a very prescriptive exercise plan that may feel punishing and may be in excess of what you actually need to care for yourself. Intuitive eating helps you tune into what feels good to your body, and then be curious about what positive effects it has.

10. Honor Your Health with Gentle Nutrition

Similar to what I just said, embracing gentle nutrition helps you make choices about changes to your diet based on what is based on solid evidence and works for your energy levels and lifestyle, and helps inoculate you against wellness hucksters promoting rigid diets that aren’t backed by science and make it all but impossible to eat at a restaurant or in another social setting.

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Carrie Dennett, MPH, RDN, is a Pacific Northwest-based registered dietitian nutritionist, freelance writer, intuitive eating counselor, author, and speaker. Her superpowers include busting nutrition myths and empowering women to feel better in their bodies and make food choices that support pleasure, nutrition and health. This post is for informational purposes only and does not constitute individualized nutrition or medical advice.

Seeking 1-on-1 nutrition counseling? Carrie offers a 6-month Food & Body program (intuitive eating, body image, mindfulness, self-compassion) and a 4-month IBS management program (low-FODMAP diet coaching with an emphasis on increasing food freedom). Visit the links to learn more and book a free intro call to see if the program is a good fit, and if we’re a good fit!

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