Month: May 2020

Food Allergies & Eating Disorders: A Dietitian’s Personal Story

Joseph Bartolone, RD shares his experiences on a podcast.

Growing up with food allergies always made me feel like there was something wrong with me. I felt like I was constantly being judged, and it was weird that I could not eat or enjoy all the foods that everyone else was eating. This led to lots of shame around the foods that I did eat. I constantly felt like there was something wrong with me because people viewed me as that boy who had to bring his lunch pail with him everywhere.

It felt like everyone was watching me every time I ate because I felt like I was doing something wrong; I felt like I was wrong. I felt that I was not made for this world and eventually I would be found out and get taken from this world sooner rather than later. I constantly heard comments about how healthy the food is that I was eating. But I always took those comments extremely personally. I felt like they were saying, “Wow, you eat so healthy”, but actually meant “Wow, you have to eat healthy because you do not deserve to enjoy food like everyone else”.

I learned how to make my own food at a young age, and this caused me to experience even more shame. When my mom would look at the foods I was cooking, I would get uncomfortable and look at her with disdain. When she asked what I was making, I would respond to her in a very condescending way. My thoughts were, “You know what I’m making, something that I have to eat because I do not deserve to eat the food that normal people enjoy”.

My food allergies led to extreme fear, a need for control, and a life that involved only wanting to stay alive out of spite for the ill health I believed that I had. I could hardly hang out with friends because if too many hours went by, then I would eventually have to get something to eat. Even in the rare event that I built up enough courage to hang out with friends, I still could not be present. All my thoughts revolved around making sure there were safe foods I could eat. If I did ever go out with friends, I would pack meals and snacks to get me through the hours that I was with them. This led to a life that was predetermined, a life that required 1-2 hours of food preparation before I could go and hang out with my friends. A last-minute event was completely out of the question. I could not go unless I have enough time to pack my food, so I would be safe.

My life was controlled by food and fear. There was no time for fun or enjoyment. Besides, there was something wrong with me so I didn’t deserve that anyway. This was the narrative: I am not normal, and that when something good happened it was a mistake. I was not meant for this world, I was never meant to enjoy anything, and I can only eat foods for survival not enjoyment.  

Only after beginning work as a registered dietitian at an eating disorders center did I realize that patients experienced the same kind of feelings around food. I realized that the judgement around food was not coming from other people, rather it was coming from myself. I saw patients struggle with the same kind of issues with control and feeling different. I saw the same fears that have haunted me for most of my life, and I felt extreme empathy. I began to learn how food allergies and eating disorders were related.

Throughout this process I have gained tremendous insight into the similarities that those with food allergies and those with eating disorders experience. I noticed that they were both fueled by the fear of not having control, that they were both focused on the feeling that there is something wrong. I noticed that avoiding foods and perfect eating were prevalent in both, and that food was viewed as something potentially harmful, rather than something that can be enjoyable. I noticed that the curiosity and search for answers can get out of hand when looking in the wrong places. I came to realize that people who struggle with food allergies and people who struggle with eating disorders do not have something wrong with them; they are actually very good at coping in order to survive. But the coping mechanisms being used are not sustainable.  

Eventually, after about 20 years of being allergic to foods, something happened. I got an allergy test again at the age of 30. The test revealed that I was no longer allergic to peanuts, wheat, soy, dairy-all of the foods that I had to avoid for most of my life. When I got the test results, I questioned the doctor and told him that the test results were probably wrong. I did not believe that what I knew my whole life was no longer true, and most of all I feared having to step into the unknown. 

I eventually began to reintroduce all of the foods I could not have for so long, and I began to feel something new when experiencing food: gratitude. Foods containing dairy, wheat, soy, and peanuts are now some of my favorite foods. I still love all of the foods that I enjoyed before as well. 

The first time I reintroduced a food to which I had previously been allergic, it was a life-changing experience. I felt as though all my problems had gone away, that I could finally be “normal”. However, after a time, I became accustomed to being able to have all these foods, and I realized that the feeling of something being fundamentally wrong with me had not magically disappeared. My thoughts changed from “people are judging me for eating the foods I am allergic to”, to “people are now judging me for eating foods I used to be allergic to”. I realized that the magical event I had wished for my whole life had happened, and yet my emotional experiences weren’t keeping pace.  Food freedom is something that everyone should get to experience, but there is no one event or circumstance that will give it to you. After I learned that I could eat whatever I wanted, I realized I still did not have food freedom. I had self- judgement, and that didn’t magically go away along with the food allergies. This made me realize that food freedom is not the ability to eat any foods that you want; it is the ability to eat what you want, when you want, without judging yourself. And this freedom can only be achieved by letting go of the thoughts that weigh you down. 


Joseph Bartolone is a Registered Dietitian with Bright Road Recovery. His work with individuals seeking to heal their relationship with food and their bodies is informed by his own experiences as well as a deep desire to create a safe and accepting environment for his patients. See his bio on our website to read more.

Allergies, ARFID and Eating Disorders

ED-Food-Allergies-ARFID-Infographic-pg-1-2

This infographic was created by our most recent dietetics intern, Teresa Landing. Teresa is completing her internship with the Cal Poly Pomona Dietetics Internship program, as she works to become a Registered Dietitian. Bright Road Recovery is proud to be a rotation site for the Cal Poly Pomona program, providing excellent training for new professionals in eating disorders and eating disorder treatment.

Food Allergies & Eating Disorders: A Dietitian’s Personal Story

Joseph Bartolone, RD shares his experiences on a podcast.

Growing up with food allergies always made me feel like there was something wrong with me. I felt like I was constantly being judged, and it was weird that I could not eat or enjoy all the foods that everyone else was eating. This led to lots of shame around the foods that I did eat. I constantly felt like there was something wrong with me because people viewed me as that boy who had to bring his lunch pail with him everywhere.

It felt like everyone was watching me every time I ate because I felt like I was doing something wrong; I felt like I was wrong. I felt that I was not made for this world and eventually I would be found out and get taken from this world sooner rather than later. I constantly heard comments about how healthy the food is that I was eating. But I always took those comments extremely personally. I felt like they were saying, “Wow, you eat so healthy”, but actually meant “Wow, you have to eat healthy because you do not deserve to enjoy food like everyone else”.

I learned how to make my own food at a young age, and this caused me to experience even more shame. When my mom would look at the foods I was cooking, I would get uncomfortable and look at her with disdain. When she asked what I was making, I would respond to her in a very condescending way. My thoughts were, “You know what I’m making, something that I have to eat because I do not deserve to eat the food that normal people enjoy”.

My food allergies led to extreme fear, a need for control, and a life that involved only wanting to stay alive out of spite for the ill health I believed that I had. I could hardly hang out with friends because if too many hours went by, then I would eventually have to get something to eat. Even in the rare event that I built up enough courage to hang out with friends, I still could not be present. All my thoughts revolved around being somewhere in which I knew there were safe foods I could eat. If I did ever go out with friends I would pack meals and snacks to get me through the hours that I was with them. This led to a life that was pre-determined, a life that required 1-2 hours of food preparation before I could go and hang out with my friends. A last-minute event was completely out of the question. I could not go unless I have enough time to pack my food, so that I know I am safe.

My life began to be controlled by food and fear. There was no time for fun or enjoyment. Besides, there was something wrong with me so I didn’t deserve that anyway. This was the narrative: I am not normal, and that when something good happened it was a mistake. I was not meant for this world, I was never meant to enjoy anything, and I can only eat foods for survival not enjoyment.  

Only after beginning work as a registered dietitian at an eating disorders center did I realize that patients experienced the same kind of feelings around food. I realized that a lot of the judgement around the foods I ate was not coming from other people, rather it was coming from myself. I saw that patient’s struggle with the same kind of issues with control and feeling different. I saw the same fears that have haunted me for most of my life, and I felt extreme empathy. I began to learn how food allergies and eating disorders were related.

Throughout this process I have gained tremendous insight into the similarities that those with food allergies and those with eating disorders experience. I noticed that they were both fueled by the fear of not having control. I noticed that they were both focused on the feeling that there is something wrong with me. I noticed that avoiding foods and perfect eating were prevalent in both for different reasons. I noticed that food was viewed as something negative, rather than something that can be enjoyable. I noticed that the curiosity and search for answers can get out of hand when looking in the wrong places. I noticed that both people that struggle with food allergies and people that struggle with eating disorders do not have something wrong with them. They are actually both very good at coping in a way that they know in order to survive. But just the coping mechanism used was not sustainable.  

Eventually, after about 20 years of being allergic to foods, something happened. I got an allergy test at the doctors one more time at the age of 30. The test revealed that I was no longer allergic to all of the foods that I had to avoid for most of my life. Peanuts, wheat, soy, dairy were the main allergies. When I got the test results, I questioned the doctor and told him that the test was probably false. I did not believe that what I knew my whole life was no longer true, and most of all I feared having to step into the unknown. 

I eventually began to reintroduce all of the foods I could not have for so long. And through reintroducing and enjoying the foods I was unable to have for so long I finally felt what I have been missing most of my life when experiencing food: gratitude. I realized that the foods I enjoy now are all of the foods that I could not have before. Foods containing dairy, wheat, soy, and peanuts are now some of my favorite foods. I still love all of the foods that I enjoyed before as well.  

I remember the first time that I reintroduced a food that I was previously allergic to. It felt like it was a life changing experience. It felt like all my problems had gone away, it felt like I can finally be normal. However, after a while of being able to eat the foods that I was previously allergic to, I started to realize that this had become my new normal. The feeling that there was something wrong with me did not magically go away when I started to eat foods that I could not eat in the past. The feeling was still there, but the way I reacted to it started to change. The thoughts changed from people are judging me for eating the foods I am not allergic to, to people are now judging me for eating foods I used to be allergic to. I realized that the magical event I had wished for my whole life had happened, and yet nothing had changed.  

Food freedom is a concept that everyone should strive for, but there is no magical event or circumstance that will give it to you. Not until after I was given a magical gift to eat whatever I wanted, did I realize that I still did not have food freedom. I still had the judgement that I put on myself, and it didn’t magically go away. This made me realize that food freedom is not the ability to eat any foods that you want; it is the ability to eat what you want, when you want, without judging yourself. And this freedom can only be achieved by letting go of the thoughts that weigh you down.  


Joseph Bartolone is a Registered Dietitian with Bright Road Recovery. His work with individuals seeking to heal their relationship with food and their bodies is informed by his own experiences as well as a deep desire to create a safe and accepting environment for his patients. See his bio on our website to read more.

When Eating Disorders Complicate Pregnancy and Postpartum

It is not uncommon for women to experience mixed emotions during pregnancy.  One moment, a woman may find herself feeling extremely excited for her new bundle of joy and the next moment worrying about the changes with her body and weight gain.  For some who have a preexisting eating disorder, pregnancy could exacerbate their symptoms and behaviors while some who have a history of eating disorders may find themselves fearful of a relapse.  Women who do not have an eating disorder history may find themselves experiencing disordered thoughts related to food, eating, and body image during pregnancy, which can be a disconcerting development.

The National Eating Disorder Association (NEDA) states that according to national surveys, 20 million women in America are estimated to have an eating disorder at some point in their lives [1].  These disorders include anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder BED), or OFSED (other specified feeding or eating disorder).  NEDA notes that an eating disorder can be triggered by pregnancy itself. 

In addition to the emotional ups and downs of pregnancy, when a woman is faced with the challenge of discontinuing eating disorder behaviors, the battle between the disorder and the need to protect their unborn child can be intense.  Many women adopt a ‘mama bear’ stance once they become pregnant: they focus on their baby’s needs for nutrition and care, and this determination helps them to abstain or reduce behaviors in order to protect their baby’s health.  

Joanie S. (not her real name), who received treatment for her eating disorder in a partial hospitalization program, shared her experience.  “I didn’t want my baby to have issues and I just needed to be healthy for nine months. There was an end date”, she said. By reminding herself about the importance of her baby’s needs and the fact that pregnancy is time-limited, she was able to hold on to the ‘mama bear’ mentality .  Although this perspective may help some women refrain from using eating disorder behaviors, others find that being pregnant and having an eating disorder cannot be separated and “ were bound to interact” [2]. 

After her baby is born, a woman’s body image dissatisfaction as well as negative attitudes toward food and eating can increase [3].  For individuals recovering from an eating disorder, negative body image is the greatest predictor of relapse.  In fact, 80% of women who had a postpartum relapse reported significant body image distress and dissatisfaction [4].  Many women find themselves trying to lose the “baby weight”, and are in danger of triggering or exacerbating their eating disorder.

Joanie described her relationship with food and her body during pregnancy as being singularly focused on taking care of her unborn child.  Becoming a “mama bear” during pregnancy staved off the eating disorder, and she didn’t experience a resurgence in behaviors until after the birth of her child.  Joanie explained that it became easy to rationalize restricting her food intake during the postpartum period.  “I felt better about myself when I wasn’t eating. I was taking care of my baby.  I was losing weight.”  Being a busy mom focusing on the needs of her infant child became an effective cover for Joanie’s eating disorder, while she was putting her own health at risk.  

Although weight gain and body changes due to pregnancy are usually associated with something natural and/or positive, for women who have an eating disorder it can be difficult to grapple with how triggering their pregnant body shape can be.  Many reported feeling fearful around weight checks with obstetricians during and after their pregnancy. Some women describe feeling fearful about how the information about their weight gain was shared with them by their physician [2]. While the postpartum period is an important time to attend to in their own healthcare, women with an eating disorder will often avoid physician visits out of shame and anxiety.

Many physicians do not screen for eating disorders or understand how to treat them.  Due to ambivalence about asking for or receiving treatment, women are often reluctant to disclose diagnoses and/or behaviors. Further, there are often gaps in coordination between maternity care and other care providers.  Joanie S., who is diagnosed with an eating disorder, stated, “I wasn’t educated about my eating disorder during pregnancy and after having my daughter.” She explained that she received an abundance of information on what to expect in terms of her child’s health and development, but did not receive any support for her eating disorder during pregnancy or postpartum.  Like Joanie, women with an eating disorder benefit from professional before, during and after pregnancy to improve their health without harmful dieting and eating disorder behaviors.

According to ANAD, eating disorder symptoms may decrease during pregnancy, which could lead to the false assumption that all is well [5].  While women are busy with their newborns, revealing their difficulties and seeking help for their eating disorder can become even more challenging.  However, eating disorders are serious disorders, and self-care is essential.  Women are encouraged to talk to their obstetrician, gynecologist, or primary care doctor about any issues that arise during and after their pregnancy.  Bringing in a list of questions/concerns during a postpartum visit is recommended.  A postpartum visit should include a full assessment of physical, psychological, emotional, and social well-being.  Reproductive life plan, including birth control, health conditions or pregnancy complications, etc. are discussed during postpartum visits. It is also important to consult with a registered dietitian, seek individual therapy and/or support groups during this time.

If you believe you have an eating disorder, there are many online screenings. Bright Road Recovery offers a screening as well as the option to print up a letter to take to your doctor.


About the author:

Joanna Bosque, LMFT-Clinical Therapist at Bright Road Recovery

Joanna Bosque, LMFT is a clinical therapist for Bright Road Recovery.  She is passionate about working collaboratively with her patients to explore their lives on a deeper level and gaining insight on how their experiences influence the choices they make. She believes in empowering patients, assisting them in achieving their goals, strengthening their relationships, and supporting them in developing a healthy relationship with food. 

When she is not working, she spends most of her time with her two children and husband. She also enjoys finding great deals, baking, catching up on TV shows, and listening to music.


References

1.NEDA. What Are Eating Disorders. The National Eating Disorder Association. 2018

2. Claydon, E.A., Davidov, D.M., Zullig, K.J. et al. Waking up every day in a body that is not yours: a qualitative research inquiry into the intersection between eating disorders and pregnancy. BMC Pregnancy Childbirth 18, 463 (2018).

3. Kimmel, M.C. Ferguson, E.H. Zerwas, S. et al. Obstetric and gynecologic problems associated with eating disorders. International Journal of Eating Disorders. Mar2016, Vol. 49 Issue 3

4.  Astrachan-Fletcher E., Veldhuis C. et al. The reciprocal effects of eating disorders and the postpartum period. A review of the literature and recommendations for clinical care. J Womens Health (Larchmt) 2008, p227-230

5. Santucci, P. Eating Disorders and Pregnancy: A comprehensive book for women and healthcare professionals. The National Association of Anorexia and Associated Disorders (2019), p129-130