On this blog, I write a lot about my non-diet approach to nutrition and healthcare, especially with regards to weight loss. I believe 100% that a person can be healthy irrespective of his or her weight, and that weight loss is in no way equatable with improved health. While many health-promoting behaviors have the side effect of weight loss for many people, this is a) not always true and b) not a causation relationship.

However, the evidence supporting diet modification in certain circumstances is unavoidable. Many health conditions can be managed through diet, and overall health can be improved so long as those dietary modifications are weighed in comparison to the potential adverse effects on the other areas of health (social, mental, spiritual, etc.) In a day and age when diet changes are trendy (and, dare I say it, idolized) it becomes even more important that healthcare practitioners are intentional, selective, and discerning when prescribing nutrition therapies. This is especially true in patients with previous or active eating disorders, and unfortunately is also a characteristic that is often overlooked.

Because of my own history with eating disorders, I am very guarded whenever my healthcare provider asks about or makes suggestions regarding my dietary habits. I realize that most primary care providers are not trained in how to handle patients with eating disorders, and often may casually make harmful comments without intending to. I’ve had physicians argue with me about my lack of exercise after I tried explaining that running was harmful to my mental health, and I was afraid to start a new regime. I’ve also been told to eat less sugar, to avoid saturated fat, and to be careful of weight gain even though the same physician had previously diagnosed me with anorexia. If that sounds confusing and contradictory, it’s because it is.

So, when I visited my school’s clinic and was recommended an “antihistamine diet,” I was pleasantly surprised when the intern was understanding of my hesitancy, and then took the time to discuss my concerns with me.

The Mysterious Case of Facial Swelling

A few months ago, I started experiencing mysterious facial swelling around my eye, forehead and cheeks. I had allergy testing done and a variety of blood tests, but the immunologist finally resigned to “stress reaction” as my diagnosis and wished me luck.

After the swelling persisted for almost an entire week and the PA at the urgent care clinic told me it was probably due to seasonal allergies because my nose was pale inside (which made me want to scream with frustration) I made an appointment with a Naturopathic intern at my school and begged him to give me a solution other than Claritin, which I had already tried. He examined me, and then leaned back against the counter and sighed.

“Do you think I have allergic rhinitis?” I asked, dejectedly.

“Well, yes. But I don’t think that’s why your eye is swollen,” was his reply.

Instead, his diagnosis was a histamine clearance dysfunction. He prescribed an herbal tincture and a natural, high-dose antihistamine, and then recommended I follow an antihistamine diet for the few weeks leading up to my wedding because I’d expressed my concern regarding my appearance. Once the swelling was under control, he said he’d like to get to the bottom of why my body was struggling to clear histamine properly.

And that’s when I explained that I was nervous about starting a diet regimen due to an eating disorder history and knowledge that restrictions have historically triggered me to spiral into unhealthy patterns. His answer was, I feel, exactly what I needed to hear: “You don’t need to follow it strictly, or see it as an added list of food rules. Just read through the list of high-histamine foods, and be aware that eating those might make your symptoms worse. Use the information to make an informed choice, like maybe not drinking champagne or eating guacamole the week of your wedding.” (Avocado and champagne are two of the foods with the highest levels of histamine per gram.)

I was encouraged and refreshed when I left the office, and was humbled and grateful when my face was completely back to normal within 24 hours. (Natural medicine, for the win!) Since then, I’ve been conscientious of the aged and fermented foods being offered to me, and generally choosing lower-histamine options instead. I’ve also been praying every day that the swelling stays far, far away.

My experience in the clinic was awesome for multiple reasons: first, it reinforced my commitment to practice holistic, patient-centered medicine; and second, it reminded me of the patient experience. Even though I own my own nutrition practice and talk about health/medicine all day, every day, it can sometimes be easy to forget about the fact that health issues can be scary for the people experiencing them. I was ultimately reminded about the importance of making my patients feel heard, encouraging them to share openly, and approaching each clinical encounter with an attitude of compassion. In some ways, I’m grateful for the complexity of my own health journey, because it has enabled me to better care for other people. 

What has been your experience with healthcare providers? Do you feel heard, or do you just feel like a number?