Dear Therapist: Is intermittent fasting safe for me? (Opinion)
Dear Therapist: I have a history of disordered eating. My eating is mostly in a good place and I am not underweight. Lately I have been suffering with terrible insomnia and digestive issues. My regular doctor hasn’t been able to help. My naturopath and a few of my friends have suggested intermittent fasting. Part of me thinks it could send me back into disordered eating but I am desperate to feel better.
Dear Conflicted About Fasting: I understand the anguish and desperation of having no diagnosis or clear treatment for your symptoms. However, even if intermittent fasting is helpful for some people, no type of food restriction plan, whether it’s fasting or keto or low carb, should ever be suggested without a thorough consideration of the risk of insufficient nourishment, best explored with a dietitian, and the risk of triggering, worsening or reactivating disordered eating.
Because eating disorders and disordered eating are widely misunderstood, well meaning practitioners and friends can fail to recognize the potential harm of suggesting food plans that restrict eating. Disordered behaviors with food are generally seen as ways of coping with psychological problems. This framing has truth but it’s not fully accurate. While there absolutely are psychological aspects of disordered eating, the key trigger and reinforcer of these behaviors is food restriction.
Food restriction can be anything from low-calorie to elimination of certain foods (even if described as non-restrictive) to food insecurity to sensory aversions that make it hard to eat. Amazingly, we humans are so sensitive to food restrictions that the restriction can even be a thought like ‘I shouldn’t be eating this’ or a feeling like ‘I feel guilt for eating this’ or an intention like ‘I’m going to have to eat less tomorrow to make up for what I’m eating now’.
Without food restriction, there’s no disordered eating and no eating disorders. This includes all disordered patterns like anxious fixation on food, undereating, binge eating, purging, and any combination of those behaviors. Not everyone faced with food restriction will spiral into disordered eating. That’s where genetics and life experiences come into play as well as context like whether the food restrictions are essential (as in Celiac disease) or part of cultural, religious or ethics-based community practices. But, everyone is at potential risk, and anyone with a history of disordered eating is highly likely to have their struggles with eating intensified or reactivated by food restriction.
So, Conflicted About Fasting, listen to the part of you that is questioning whether intermittent fasting is safe for you. Disordered eating damages mental, physical and emotional health. It can be life-threatening. This is true for people of all body shapes and sizes. The fact that you are not underweight does not mean that a food restriction plan is any less risky.
Focus on ways to eat adequately and consistently – which I’m guessing is made even more difficult by your digestive issues – instead of food restriction. In my experience, many who say they are mostly in a good place with their eating after a history of disordered eating continue to struggle to eat enough consistently, regardless of body size. Since poor sleep and digestive issues are common with inadequate or irregular nourishment (doesn’t mean that’s necessarily the cause of your issues or that there aren’t other reasons for your symptoms), any approach to improve health needs to be grounded in your continued recovery from disordered eating.
You can let your naturopath know that you are open to all the ways they can help you as long as it doesn’t involve food restriction. You can have your friends read this letter or just say thanks and then not follow their advice. If at any point you weigh the risks versus potential benefits and decide to try some type of food restriction, be vigilant of signs it’s derailing the progress you have made with food and seek support to reduce the chance of a backslide. There’s no perfect way to navigate these complex mental health and physical health issues. All we can do is keep trying.
Danielle B. Grossman, Licensed Marriage and Family Therapist, has worked with clients in the Truckee/Tahoe community for 20 years. She helps couples and individuals with their relationships, anxiety, grief, struggles with food and addiction. Reach out at email@example.com or learn more at truckeecounseling.com
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