Navigating Chronic Illness and Recovery with Anita Dharwadkar, RD, LDN
There are so many different types of chronic illnesses, from IBS to Crohn's Disease, that make healing your relationship with food infinitely more complicated.
It’s not as simple as “read the intuitive eating book and just eat when you’re hungry!” (let’s be real – that’s a boiled-down version of intuitive eating, anyway). When someone’s body responds differently to different foods due to a chronic illness, how do they navigate recovery from disordered eating and heal their relationship with food?
Anita Dharwadkar talks with me today about just that. If you struggle with a chronic illness and eating disorders, then this episode is for you… but even if you don’t, this is a really interesting conversation that will allow you to pick out pieces that do apply to you – and help you understand that recovery and intuitive eating is not a one-size-fits-all process.
Listen to the Episode Now
Anita is a Registered Dietitian who practices in the Boston area. She’s an anti-diet dietitian who practices Health at Every Size. She’s been trained to work with chronic illness and eating disorders and has worked with all levels of care.
Right now, she’s working as an outpatient nutrition therapist in Cambridge, Massachusetts with Marci Evans (who was actually on the podcast a few weeks ago!) Anita has a passion for working with the intersection of eating disorders and chronic illness, specifically in adolescents.
Read on for our discussion about the complexities of navigating recovery from an eating disorder with a chronic illness.
What do we mean by “chronic illness”?
A lot of the time, we think of chronic illness as something that affects someone only physically. However, we know that things which affect someone physically often by extension affect them mentally – something that is often overlooked in the healthcare system, Anita notes.
She defines “chronic illness” as a diagnosis or set of symptoms that someone suffers from on a daily basis that impacts all aspects of their physical, mental, emotional, and spiritual well being. It’s a condition that impacts their quality of life even if there is no fancy name for it.
Chronic illness doesn’t discriminate. It affects people of all ages, genders, races, economic status, and abilities. So, for example, just because someone is young and may otherwise appear to be “healthy,” it doesn’t mean they aren’t suffering from chronic illness. Weirdly, doctors tend to overlook this.
Examples of Chronic Illnesses
Examples of chronic illnesses that are common in the US include diabetes, high blood pressure, arthritis, PCOS, endometriosis, IBS, and fibromyalgia. The list is endless, but the scope of this episode will cover gastrointestinal (GI)-based chronic illnesses.
IBS, or Irritable Bowel Syndrome, is a common chronic illness that affects the GI tract. IBS presents as a set of symptoms not connected to a disease in your digestive tract. This is often confused with IBD (Inflammatory Bowel Disease), which is an umbrella term used to describe autoimmune conditions (such as Crohn's and colitis) that affect the gastrointestinal (GI) tract.
How Connected are Nutrition and Chronic Illness?
Most chronic illnesses have some sort of nutritional implications. People with chronic illnesses might be on medications that don’t mix well with certain foods, or they might try to avoid or increase certain foods to eliminate symptoms. It gets even more complicated because it’s hard to tell which came first, the food that leads to an exacerbation of symptoms or the illness that causes the discomfort with food.
So with it all being very complex and individualized, throw in all the messages we hear from diet culture. “Eliminate dairy or gluten,” or “try a new probiotic,” and so on, it gets even stickier.
There are so many factors, and everyone’s case is so individual, so it’s very important to consult a medical doctor and dietitian to ensure whatever changes you want to make are scientifically-backed up and won’t harm you mentally or physically.
Meaning, if a diet change does wonders for you physically, but it tanks your emotional or mental health, then it’s not exactly a change that’s working.
Food Sensitivities vs. Intolerances vs. Allergies
A lot of the time, people with chronic illnesses experience food sensitivities or intolerances that go along with their autoimmune condition. There are blood tests that are scientifically-backed that can reveal any food sensitivities you might have.
We kind of use the terms interchangeably sometimes but there’s a difference between food sensitivities and food intolerances. Food intolerances mean you have difficulty digesting certain foods. They’ll cause you GI distress, such as bloating, gas, diarrhea, or heartburn. Lactose intolerance is a really common example of this.
Food sensitivities, on the other hand, can develop at any time and can change over time. People with food sensitivities can experience things like joint pain, skin issues like eczema, stomach pain, fatigue, and brain fog. You can test for this via a blood test with an allergist and find out if you can have this food in small amounts, or not at all.
Food allergy is probably the one we’re most familiar with. People with allergies – common ones are shellfish or peanuts – will eat a food they’re allergic to and have an anaphylactic reaction, or an immune system reaction. They might get hives, experience their throat closing, and have difficulty breathing. These people should absolutely avoid those foods if they have an allergy.
Chronic Illness with Food Sensitivity
There are a lot of people – especially in the eating disorder community – that frown on the idea of avoiding a specific food when you don’t have an allergy to it, or autoimmune disease. For example, someone who is avoiding gluten without having Celiac’s Disease. That’s because it’s so common to hide behind a reason that may not seem to be related to weight loss, food fears, or disordered eating in order to cut something out of one’s diet.
But, it’s not so clear cut. Not every single person who goes dairy free without a milk allergy is hiding behind their eating disorder. It can also be partly because it feels safer and partly because their body has some sort of reaction. So, how do you approach this during recovery? Anita talks about taking a very individualized approach to each client.
She might try to find out about that client: what is the history of gluten with that person? Is the whole family gluten-free? Is there some sort of trauma history surrounding foods high in carbohydrates?
It’s so important to try to understand where they are coming from, and try to validate their pain if they are saying a food causes them pain. It may very well cause them pain, whether it’s physical or psychosomatic pain.
In the end, it’s a complex issue that deserves investigation.
If someone experiences a chronic illness and eating disorders… Now what?
It’s like the chicken or the egg… what is causing which issue? It can be nearly impossible to know.
When someone comes to Anita with a chronic illness and eating disorder, she first ensures they have the right support people in place: a therapist, dietitian, and medical team all knowledgeable in disordered eating.
Then, because bingeing, purging, and restriction will put more stress on an already sensitive system, Anita will educate clients on normal symptoms after reintroducing food. It might be uncomfortable while going through renourishing, but consistency is so important. The discomfort doesn’t necessarily mean they have a sensitivity.
Consistency will help retrain a client’s mind and your body to expect food at different times, and will help them get in a variety of foods. This variety of foods will not only provide all the necessary nutrients, but will ensure a healthy microbiome (meaning, a proper mix of good and bad gut bacteria).
Anita also works with her clients on their anxiety and stress levels, since stress can severely affect the GI tract and ability to eat. She helps them manage their stress with hobbies they enjoy, support from family and friends, and self-care.
Her last bit of advice to clients: “Be gentle with yourself… you didn’t develop disordered eating overnight, it’s going to take time.”
Fear Foods
When do you open the discussion about foods a client is avoiding? And do you challenge it, or continue to avoid it?
Anita notes that, as with this entire process, it is very individualized. Sensing a pattern here?
She usually starts with how often this food is showing up for this person. Are they asking about it often, and right away? Is it always on their mind?
Then, is it inhibiting them from being able to eat other foods and adequately nourish themselves? If so, it’d have to be addressed early on.
If it seems to be a fear food, she first asks if this is a food they ate prior to their eating disorder. If they did, it would seem to be an anxiety-provoking food more so than a GI-issue food.
Sometimes, she will get together with the client and their family, so they feel supported, and set “baby goals” – maybe on day one, they will just sit and look at the food together. Maybe the next day, they will touch it. Eventually, they will take a bite. Anita explains that this would be a helpful process to do alongside learning how to renourish themselves.
Tweetable Quotes
“Be gentle with yourself. Know that this isn’t going to happen overnight. You didn’t develop disordered eating… overnight, it’s going to take time and that’s frustrating.” – Anita Dharwadkar, RD, LDN
“Every time that you are choosing to eat, you’re making a good, nourishing choice and getting yourself one step closer.” – Anita Dharwadkar, RD, LDN
Resources:
Anita’s Instagram, @Dietitian_Anita