Read Part 1
The Impossible Pursuit of Perfection
One thing I worried about when I started to change my eating was becoming obsessive about food. I have a history of that. Not full blown eating disorder-level. But I have to watch myself. I know I have the capacity to get to a really disordered place. So, I wanted to know how to incorporate food changes for managing chronic illness with a Health at Every Size approach. Unfortunately, I couldn’t find much out there to help guide me (hence this series). Most of what I found wasn’t really geared toward people with serious chronic illness. I did listen to a podcast over at Food Psych about elimination diets and eating disorders. What I took away from it is that I should be cautious about expanding my elimination beyond my initial targets and that I needed to watch myself for the pursuit of some kind of “perfect” diet and “perfect” symptom control. That is, elimination diets in chronic illness can lead to orthorexia.
I also knew from my HAES reading that another disordered pattern of perfectionist thinking I needed to avoid was “good food”/”bad food” thinking. For example, my food changes needed to resist the idea that the foods I don’t eat are “bad” foods. Cheese is not a bad food. It is a delicious and nutritious food for many people. It is an excellent way of preserving dairy for consumption at a later date. Cheese is the shiz! Cheese isn’t bad. My body isn’t bad. They just don’t play well together. For people who aren’t already dealing with a lot of inflammation, cheese probably doesn’t give them much trouble. For me, shucks, I’ll elect to get my salty-creamy-goodness from something else (like cashews).
As an adjunct to this idea, I also knew that I needed to avoid attaching a moral value to my new food plan. I needed to not see myself as engaged in some kind of morally superior pursuit of health. Wow, it is hard not to get seduced back into this one, especially when food moralizing is all around us! For example, at a work buffet luncheon, I was chatting with a colleague I don’t know well. As we got closer to the food, I got excited because they had labeled the food clearly so I knew what food met my eating plan. I explained my excitement to my coworker who replied, “Good for you! You are so healthy. I should cut [x food], too.” She had no idea how sick I actually was (hello invisible illness!). There might have been a tinge of over-congratulating me because of my size, too.
At a different time in my life, I would have swelled with pride at the moral goodness of my food choices. This time I let her know that I wouldn’t have cut out such a key food without a serious reason, hoping to subtly demonstrate I didn’t share her moral stance on food. It was important for me to express that to avoid internalizing her praise. Avoiding good food/bad food moralizing is important for another reason. It helps keep me active in my food choice. What I mean is, resisting moralizing helps me remember that I am choosing to eat differently for a purpose–better function. I am not obligated to eat differently because it is “right” or “good” or “correct.” For me, this helps keep me out of orthorexia-land.
So much of disordered eating relates to perfectionism. The trick about eating for chronic illness is that we have yet another entry point to disordered thinking–the pursuit of perfect control of our illnesses. This is something I find myself seduced by even with respect to supplements. But deep down, I know it isn’t possible. Perfect control of a chronic illness is unrealistic. There will be flares. Even before I was fully diagnosed, I knew this from my experience with asthma. Not even the most perfect medication can prevent every flare. So, I try to keep that in mind about my food and supplement choices. It is a fine line to walk. Especially when I’m feeling poorly and I need to be extra careful about what I eat.
Experimental Attitude
What all this means for me now is that I periodically re-challenge foods I’ve eliminated. I am working on several things to improve my body’s function and I have made a lot of progress! My migraines are happening only about once every couple of months. And usually when I have one there is a very clear trigger. The body changes and even heals, sometimes! It may be that I can reintroduce some foods over time. I won’t know unless I try. And that will mean a few flares I bring on myself. It’s all an experiment! Maintaining an experimental attitude helps me to avoid becoming fixed and stuck in my eating plan.
I want to take a minute to acknowledge that this kind of experimentation applies nicely to food “sensitivities.” It doesn’t work so well for those who experience anaphylaxis (whether due to IgE mediate allergies or MCAS). For those folks, strictness is important. But, as Allergy Girl Eats writer, Kortney discusses, the fear of anaphylaxis can also hide eating disorders. I hope she and others write more about the intersection of eating disorders/disordered eating and illness that require strict management of food (such as allergy, celiac, and diabetes).
As I’ve continued on this journey, I have seen so very many food plans (some are truly diets) promoted as cures to whatever ails us: Keto, autoimmune protocol, FODMAPS, low histamine, low tyramine, etc. I do not doubt for a minute that food is important to managing illness. And, many folks have had good luck with some of these food plans. But I worry that often times we position food as the enemy. That’s easy to do, especially for folks with anaphylactic reactions or with gastroparesis. So much of the advice out there is about what not to eat. I think in our pursuit of perfect symptom management sometimes we run the risk of forgetting that we need proper nutrition–most especially if we are unwell. In the pursuit of perfect control, we can throw the nutritional baby out with the bath water. On the other hand, for some folks, perfect nutrition will never be possible because of the limitations of their illness.
Perfection of any kind is a pipe dream. Continuous experimentation helps keep me in a fluid place, but it can feed into a quest for perfection as you’ll see below. Caution is warranted!
Warning Signs
Several months ago, I talked with my nutritionist and naturopath about the low histamine diet. They both discouraged me from strictly following it because they felt that benefits to MCAS control would not outweigh the nutritional deficiencies of the diet. I also mentioned the idea to my therapist and she exclaimed, “You can’t go on a diet. You are already on a diet!”
The comment struck me. Was I on a diet? I didn’t mean to be on one! I think she meant it as joking comment–as a way to acknowledge that my food plan is challenging enough as it is. And she’s right! But it got me thinking: If you, like me, are a recovering dieter finding themselves pulled back into the world of restrictive eating, it can be overwhelming to figure out what is a “diet” and what is a food plan that might help you feel better.
In my case, my MCAS has been fairly well controlled by the food changes I’ve already made and my medications/supplement regimen. Experimenting with low histamine–for me–would be pursuing perfection. AND, it would further reduce variety which is not nutritionally wise, nor does it facilitate “normal” eating. That’s the red flag. I decided to follow my team’s advice. Not only is a low histamine diet unlikely to give me much greater benefit, I think the toll on my mental health would be too heavy. I need to think holistically about what is healthy for me. That includes my mental health. More food changes, reduced variety, and less nutrition isn’t going to do me any favors physically or mentally.
I think it can help folks like me to know what the warning signs of disordered eating are. There is a lot out there about this, but this list is geared toward the context of chronic illness. Watch for this in your food plan–either intrinsically, or in the way you implement it:
- “Good” / “Bad” food or moralistic thinking
- Eliminations without challenges (except for anaphylaxis, celiac, diabetes, etc)
- Pursuit of total symptom control
- Requiring perfect adherence to the plan (except for anaphylaxis, celiac, diabetes, etc)
- All food, all the time: Obsessive thinking about food outside of mealtimes/meal planning
- Weight-focused rather than well-being focused
- Privileging physical health over mental health or seeing them as separate
- Discouraging intuitive eating
Because I tend to be a visual thinker, I made this flow chart to help. Let’s call it a draft. I am certain it is missing something–let me know in the comments. If you are wondering if your food plan might be a diet in disguise, give it a try.
The point is that we always have to be careful! Pay attention to your goals and thoughts about food as you alter you food plan in the pursuit of better functioning. Watch for the warning signs. Whether the fault is in the “plan” itself or in our approach to it, we don’t make food changes in a vacuum, but in the context of a toxic diet culture. That means, if we are prone to perfectionism we run the risk of sliding into disordered patterns of behavior. If you are recovering from an eating disorder, you must be especially careful and work with your support team to monitor your implementation of any food changes.
I suspect that those of us with EDS/MCAS/dysautonomia are particularly prone to disordered patterns as our conditions often increase our fight/flight response. The pursuit of perfectionism can result from our pain and desperation and it can also become a coping mechanism for modulating our elevated adrenaline–a maladaptive way of self-soothing. The challenge is to find other ways, self-compassion, trust, and perhaps medication (whether for POTS or for anxiety/depression) to regulate our fight/flight response rather than self-destructive patterns. NOT any easy task!
In part three I will discuss the shift I have made toward thinking about nourishment in a holistic sense to counter the pursuit of perfection. Watch this space!