For those of you who don’t know, my niche in the area of healthcare is integrative medicine (AKA “functional” medicine). However, I also fully believe in a health at every size and intuitive eating framework. Understandably, I get a lot of questions about how I incorporate a non-diet approach into my integrative medicine work, which focuses largely on lifestyle factors like nutrition. I’ve touched on this topic before, but I wanted to address it more formally since I receive questions about it so often.
[If you’re wondering what functional medicine is, I’ll explain more later. But if you’re unfamiliar with it, don’t google it! Negative media exposure has given the term a bad reputation, but the framework is gaining more acceptance in the medical community. Northwestern University, the Mayo Clinic and the Cleveland Clinic all have practitioners on staff who practice from a functional medicine perspective. So, if you’re skeptical, follow those links, first.]
Intuitive Eating 101
The phrase “intuitive eating” refers to a rules-free approach to nutrition in which all foods fit, and a person uses internal cues to guide what, when, and how much to eat. What this looks like in practice is eating pancakes for breakfast because they sound good, but also choosing some eggs, armed by the knowledge that without protein, your blood sugar would crash soon afterwards. Likewise, intuitive eating may mean eating a salad for lunch instead of pizza, because a heavy meal mid-day might make you too sluggish to finish your afternoon responsibilities. But most importantly, intuitive eating means eating a brownie if you’ve been craving one all day instead of resisting and resisting until you can’t anymore, and then binge eating the entire pan of brownies.
In summary, intuitive eating means making satisfying choices that are informed by knowledge of hunger, fullness, and how different foods make you feel, all without creating external rules. Intuitive eating applies to all eating contexts, whether that be food allergies, medically necessary diets, thin individuals, or overweight individuals.
As a healthcare provider, my job is to uncover the root cause of my patients’ symptoms, make an accurate diagnosis, and then offer a targeted therapy that is safe, effective, and does no harm. Part of the clinical reasoning required for this role involves working with my patients to decide the approach that works best for them, in the context of their individual lives. In the field of integrative/functional medicine, this often means putting together a non-invasive treatment plan (non-surgical, drug-free) to help my patients return to health and cultivate balanced, fulfilling lives. Sometimes this means making diet changes, sometimes it means working on stress management, and sometimes it means a much more in-depth exploration of the pathology, using nutraceuticals to correct hormonal imbalances, inflammation, neurotransmitter deficiencies, and more.
Intuitive Eating at Work
In my work, my background with eating disorders and commitment to intuitive eating shows up in two ways: 1) diagnosis and 2) holistic treatment plans.
Many of my patients present with vague symptoms like fatigue, widespread pain, dry skin, feeling cold all the time, or irregular menses. In these cases, the diagnosis isn’t as simple as taking an x-ray and identifying a broken bone. Typically, these symptoms point to a more systemic cause, such as autoimmune disease, Lyme disease, or chronic infections.
But sometimes, they’re behavioral. See, the specific symptoms I mentioned above — fatigue, pain, dry skin, feeling cold, and abnormal periods — also may result from chronic undereating. When energy intake is too low, the body starts to consume itself. Fatigue comes from lack of fuel, pain comes from muscles wasting away, dry skin, feeling cold, and abnormal periods signify whole body systems literally shutting down to save energy. Even if a patient isn’t underweight, they can still suffer these effects of undernourishment. In fact, they often do! Malnutrition due to inadequate consumption of food is something I commonly uncover in my patients.
Understanding the subtle, sneaky nature of disordered eating helps makes me a better doctor because it helps me know where to look. In fact, disordered eating is so common that it’s often the first place I look when patients describe those symptoms to me. I ask about the eating habits of each and every one of my patients — and not just that, but I ask about their relationship with food, too.
If a patient’s symptoms result from disordered eating, the obvious treatment is to heal the disordered eating.
But for patients whose symptoms point to an underlying pathology, behavioral coaching won’t be sufficient. With conditions like lupus, Crohn’s, Lyme disease, thyroid disease, etc., a more complex intervention is needed in order to help that patient return to health. Often, dietary modifications are a piece of that puzzle.
My background in eating disorders and commitment to intuitive eating equip me with the knowledge that diets — even medically necessary ones — can easily trigger disordered eating behavior and even eating disorders. This is another reason I screen my patients for disordered eating at the very first appointment, and continue to check in with them about their relationship with food at regular intervals. Especially if part of the treatment plan involves dietary modification, I want to make sure that the stress of such an intervention isn’t creating more harm than good for that patient in terms of their mental, emotional or spiritual health. If my patients show red flag symptoms of disordered eating (like a long term history of yo-yo dieting, body image struggles, or a history of eating disorders) I avoid nutrition therapy as much as possible. Of course, with allergies and food intolerance, some restrictions are necessary — in those instances, the food really is the root cause. But I am careful in the way I present the topic to my patients.
Health at Every Size
Another facet of my practice framework is “Health at Every Size” which is a paradigm recognizing that weight alone does not offer enough insight into a person’s health. While I do weigh my patients, I am careful not to make preconceived judgments about their health based off their weight. I recognize that pathology in large-bodied individuals is not necessarily related to their level of body fat; likewise, I don’t assume that my thin patients are eating in a healthy, balanced way.
Especially in the integrative medicine realm, sensitivity to disordered eating and eating disorders is not the norm. I find that most of my colleagues lack awareness of the magnitude of the problem of diet obsessions in our culture, and don’t recognize that patient suffering can be exacerbated by diet recommendations in certain contexts.
At the same time, I find that many practitioners in the HAES/Intuitive Eating space fail to acknowledge the benefit of certain diets in disease treatment. I find that folks tend to view things in an either-or sense, as either NO diet modification or ONLY diet modification. My personal desire as a healthcare provider is to help bridge that gap.