IBS: Why diets can fail.
Sam Bearfoot, nutritionist, kinaesiologist, and health adviser, who writes under the soubriquet ‘The Digestion Detective’ wrote to me recently. ‘I work with many clients, but in recent years I’ve had a good few come to me as a result of being on the FODMAP elimination diet with awful results. Often they feel worse than when they started; feelings are made worse by the fact that they can’t eat anything that resembles a good varied diet. Now I know this approach works for some but I’ve never actually met them. For me, The low FODMAP diet is very much a band aid approach and does little to explain why people get themselves into a digestive pickle in the first place.’
Not everybody would agree. I receive as many emails from people who report how a low FODMAP diet has transformed their lives with IBS as I do from people who have had a dreadful time. It is partly to guide clients through the difficult times that the proponents of the low FODMAP diet stress the importance of supervision by a FODMAP trained dietitian.
I will be considering the benefits and deficits of the low FODMAP diet in another post. Here I would like to explore with you why diets, not just low FODMAP diets but also weight reducing diets, low carbohydrate diets, low fat diets, high fibre diets, the Paleo diet, the Atkins diet, so often fail. This, I believe, has a lot to do with the emotional attachments we form with the food we eat.
Food, a component of attachment
As we grow, we don’t only develop our mind and our body, we also build an environment around ourselves. At first this is very small, our cot and our pram, but as we get bigger, it grows to encompass the house we live in, the toys we play with, our family, friends, school, town, football team, college, job and so on. As we develop our expanding world and form emotional connections with its various components, these become representations of who we are. The people we live with, our work, the house we occupy, the car we drive, our possessions, our books, but also our interests, our routines confer a sense of familiarity and with it security. They constitute our identity. We know ourselves through the world around us.
Perhaps the most important component of our environment is the food that we eat. Our food preferences, like everything else, are primarily conditioned within the family. For most of us, the food we ate as a child was a key component of the relationship we had with our mother. It was she who fed us, weaning us on to items of food that we learnt to associate with being cared for. Although our attachments with different foods changed as we left the influence of home, familiar items of food still conveyed a sense of well being and belonging. We form habits around the foods that we like, eating much the same from day to day and filling our shopping trolley with the same selection of items. These only satisfy our physiological requirements for hunger, they also assuage our emotional need for attachment.
Family life in the 21st century is very busy. With both parents working and the responsibilities for a home and worries over money, parents struggle to find the time to care for the emotional needs of the family. Food can therefore be a surrogate to comfort, pacify and substitute for playful face to face connection. Energy dense chocolate, ice cream, crisps, biscuits may compensate for the lack of intense physical attachment a neglected and insecure child requires. This raises the question: to what extent can the epidemic or overeating and obesity be seen as a compensation for love?
When conditioning can go wrong
Our attachment to food is not always positive. For some people, their food can be source of anxiety and even pain. This might be because of some disease in the gut or it may conditioned by an upsetting experience in the context of a meal. Sickness resulting from overindulgence, or being made to eat a particular food because it was ‘good for us’, may produce a dislike of that food. Food aversions can be instigated by a bout of illness. This may be associated with something in the food, an attack of gastroenteritis, or it might be brought on by the emotional connotations of that meal.
Mealtimes can be a cauldron of emotion. When family, friends and acquaintances get together over a meal, it may be a really happy occasion, but arguments, embarrassments, disappointments and secrets may also be disclosed. These may be felt as sickness, indigestion and pain and gut upset which can put us off eating and can lead to longstanding food intolerances. Food can have such upsetting connotations. Even the knowledge that particular foods are bad for us can cause fear and tension around eating that may spoil the enjoyment of a meal and cause an aversion to those foods. Food and mood are so entwined, but instead of reflecting on what a particular food might mean for them, people are more likely to regard it as an illness, something wrong with the food or their gut and take the problem to the doctor.
Why dieting often fails?
The attachment we have to our food is one of the most difficult things to change. So many memories (comforts or fears), are associated with food, so ‘when the chips are down’, we are reluctant to give up what reassures, relaxes and comforts us, no matter what the health gains might be and unwilling to eat bland or controlling foods that may have negative connotations.
Breaking an attachment to a much loved food is like breaking an attachment to a much loved person. It is a loss and we grieve for it. Dietitians are experts in advising people what may constitute a healthy or pain-free diet, but may ignore the strength of our psychological attachments to food. This may cause them to underestimate the emotional work a person has to undertake to alter a familiar diet, irrespective of its nutritional credentials.
It is not an exaggeration to suggest that dieting for many, can be a form of grief. Why would anybody want to replace the comfort and security of the food they have become attached to by the control and stricture of the diet, especially if that distances them from the reassurance of family and community? The enforced regulation of a diet by professional directive can heighten a sense of guilt and shame and may feel like punishment, negative feelings that may only be assuaged by indulgence in the prohibited food. Meals, after all, are to be enjoyed.
So while diets may reduce the biological intolerance to certain foods, they may exacerbate a sensitivity to separation and rejection and lead to a conflict in the gut. The low FODMAP diet has an additional wrench. Having found that exclusion of FODMAPs alleviates their pain and discomfort, they may face the admonishments of the reintroduction phase with fear and a return of their symptoms, but now they have the added risk of nutritional deficiency.
Is there another way?
As the EU referendum approaches, it is becoming more apparent that people don’t always do things, like voting and eating, because they balance the evidence and are convinced it is the right thing to do. People decide about most aspects of their lives because it ‘feels’ right, based on their personal experience. That is why both Remain and Brexit factions emphasise the familiarity of one option over the threat of the unknown.
Dieting like voting has long term consequences. It can only work if we can make the decision their own and form an attachment to it. For that there needs to be an emotional pay back. Taking charge of the food that we you eat is an important step. In our recent book, ‘Cooking for the Sensitive Gut’, published by Pavilion in January 2016, our message is that eating with IBS must neither be a torture nor a penance. Our emphasis is to motivate and inspire people to prepare and eat foods that are healthy and calm their sensitive gut with a selection of delicious and attractive recipes that are simple to cook and use ingredients available at most supermarkets. Our aim is to inspire and motivate by showing you what you can prepare and eat rather than telling you what you can’t. The message is that if changing to a more healthy diet can be a positive experience, it is much more likely to succeed and lead to personal growth.
The Sensitive Gut 
The photograph at the top of this article says it all !!!! Its so important to love and enjoy the food one eats.
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