“How I tried an elimination diet - and ended up bulimic”
Firstly, I’d like to thank Mia for sharing her story. Though Mia’s story is deeply personal, it addresses issues which many of us may face. Stress-induced irritable bowel syndrome led to terrible consequences for Mia. A diet driven solution led to more problems, including bulimia, as Mia wasn’t offered the help she needed. This is the story of her recovery.
“I was in almost constant pain and feeling desperate. I had been diagnosed with Irritable Bowel Syndrome (IBS). I searched the internet and quickly found information promoting FODMAP, a diet designed to help people with digestive disorders including IBS and Crohn’s.
It’s a diet I now know well. And it is a diet, like so many promoting elimination, that appears to offer a straightforward solution but may cause further problems.
It promised to cure IBS by avoiding any food that might trigger symptoms, including gluten, lactose, blackberries, asparagus, onion, garlic, mango, apple, nectarine, plum, dates, prunes, camomile tea, cherries, avocado, too many nuts, too much fruit at once, cream cheese, broccoli, honey and chai. The list was endless.
I was daunted, but I felt reassured that it was promoted on the NHS website. For the first six weeks, I followed the diet down to the letter. Miraculously, my IBS symptoms all but disappeared.
As I continued my research and reading I kept finding news of the latest diet promising miraculous results. Whether it’s fat-free, low carb, gluten or sugar-free, it seems we’re constantly bombarded with information about what we should and shouldn’t be putting in our mouths. This is often based on questionable science.
Many of these diets have one thing in common: elimination. By cutting out certain food groups or ingredients we can improve our health, and bodies, for ever.
At the same time, as I followed FODMAP, I dropped six kilos to become almost underweight. With so many ingredients banned, I was barely eating. My friends commented on how ‘tiny’ I looked and my mum admitted she was worried about me. But I liked the attention: I could wear clothes I had never felt comfortable in before and for a while felt more confident.
Then, a new role at work meant I was working long hours and could no longer rigidly control everything I ate. I suddenly found myself unable to keep up with FODMAP. I can only describe that moment as a terrifying loss of control that soon plunged me into total chaos.
Suddenly, food became my worst enemy and I began to have panic attacks at meal times. Eating out was a nightmare and going to dinner parties filled me with dread. At the same time, I felt like my body was beyond my control, getting fatter by the day as I inevitably regained the weight I had lost so quickly.
My relationship with food was destroyed. I was convinced that all the ingredients on FODMAP’s list would poison me and make me ill. That was only confirmed in my mind by the fact that I suddenly seemed to react to everything I ate. I was constantly tired and bloated. I woke up every morning with a sharp pain in my stomach, which only relented when I went to sleep.
One day, after a particularly big meal, I felt awful: bloated, fat, full of forbidden FODMAPs. I felt anxious, and urgently wanted to get that food out of me. For the first time in my life, I went to the toilet and made myself sick.
It felt as miraculous as FODMAP had: the pain in my tummy practically evaporated and I felt sudden relief that none of the food I had just eaten could harm me. Soon purging became a regular habit, serving a double purpose: eliminating FODMAP ingredients and calories in one easy step.
For months, I persuaded myself that I was purging to help my IBS. I was quite literally eliminating the ingredients FODMAP had banned. It was easier this way: I was no longer a nuisance at dinner parties or in restaurants and I could control what I was eating.
Meanwhile, my preoccupation with my weight began to consume me. I woke up to a voice bullying me into hating myself. The only escape from it would be going to sleep. I started taking sleeping pills at one point to turn it off and get a full night’s sleep. But I felt like I was going mad. I stared at myself obsessively in front of the mirror, focusing on my thighs, then my stomach, then my arms, then my back.
Then, I went on holiday and made myself sick every day. It was my personal rock bottom. On the last night, I sat in bed in tears, exhausted from my behaviour and from the torment in my mind. It was finally dawning on me that I wasn’t well. I tentatively looked up bulimia and slowly everything fell into place.
I sought help immediately and began working with a psychotherapist, Mary Wood. Through weekly therapy sessions, Mary helped me to understand that FODMAP had severely damaged my relationship with food, even using the word ‘trauma’ to describe the effect it had had on my eating.
But Mary also helped me understand that I was using food and bulimia as a way to distract from what I was feeling. I was swimming in anxiety after a horrible break up. My self-esteem was almost non-existent after floundering in a job I hated.
I had never made the connection, but my tummy trouble had started just as stress had really begun to affect me, first during a gruelling Masters course then in a job I wasn't enjoying. In both scenarios, I was constantly questioning if I was good enough and felt like I was only just keeping up with the work.
The main cause of my IBS, it turned out, had never been food: it was stress. Research has shown that IBS sufferers are more likely to suffer from anxiety and depression. Why had no GP, no dietitian, ever asked me about my stress levels or if I was feeling anxious? Guiding patients with depressive tendencies to a restrictive diet that has the potential to be so dangerous, instead of determining the root causes, seems to me a toxic idea.
After months of therapy I am now bulimia free. And, most importantly, I have now learned how to control my anxiety, which has, in turn, cured my IBS.
I feel compelled to share my story for a number of reasons.
I think anyone suffering from IBS should know that FODMAP is not the only option for them and that there may be unforeseen consequences. If they do decide to embark on it they should ensure they get the professional guidance they need.
I believe all elimination diets should be approached with care and an understanding of the impact they can have on a person’s eating and psychological well being.
My experience has taught me that our relationship with food is complex. Simplistic diet-driven solutions fail to take into account a person’s individual psychological and physiological response to an externally imposed diet. For me a strictly prescribed diet simply added to my stress.
After reaching my lowest point emotionally and physically, I did find the right person to help me. And then I started an exciting journey which has bought me to a point where I regained my confidence and health and I have a joyful relationship with food.”