Intuitive Eating with Food Allergies

This post was written by Caitlyn Corradino, founder of
F.I.T.4ALL and my amazing, allergy-suffering intern.

Anyone that is familiar with Intuitive Eating knows that two of the most important components of this practice are letting go of food rules and giving yourself unconditional permission to eat.

But what if someone has a medical condition, like a food allergy or Celiac Disease, and their doctor has prescribed them a restricted diet? Can that person still be an intuitive eater? As someone living with clinically-indicated allergies to peanuts, wheat, and oat, I believe that the answer is yes!

Before I share my intuitive eating experience, it is important to define the differences between a food allergy, a food intolerance, and Celiac Disease. These conditions are commonly misunderstood to be the same thing, but they are distinct:

Food Allergies

A food allergy is a response that occurs when the body’s immune system mistakes a particular food for a harmful substance. The allergic response will happen every time the particular food is eaten. IgE antibodies are released, instigating a defense against the food through a release of chemicals like histamine, causing the allergic reaction. Symptoms of an allergic reaction can manifest in rashes, itching, hives, or swelling or in more severe ways like difficulty breathing and loss of consciousness. Severe symptoms are usually referred to as anaphylaxis. Anaphylaxis may quickly become “anaphylactic shock,” which occurs when there is inadequate blood flow to critical organs of the body during an allergic reaction; this means an allergic reaction can be immediately fatal. Individuals with food allergies are not only prescribed to avoid certain allergens, but to carry an epinephrine auto-injector (EpiPen) and antihistamines with them at all times to quickly treat anaphylaxis.

Diagnosing Food Allergies

There are many tests used to diagnose food allergies, including skin prick tests, patch tests, and blood tests. Unfortunately, the only test with 100% accuracy is an “oral food challenge,” where an individual consumes the food in a clinical setting and medical providers supervise them to observe the reaction. (Note: If an individual has already had an episode of anaphylaxis associated with a particular food, doctors may diagnose the allergy without running any test, especially if they already know that an immediate family member has food allergies. Research has shown there may be a genetic component to developing a food allergy).

Food Intolerances

A food intolerance doesn’t involve an immune system response. An intolerance is an inability to properly process or digest a food. The reaction may manifest in subtle to severe GI symptoms, rashes, fatigue, or congestion. Food intolerances do not result in anaphylaxis. Further, with intolerances, you may be able to prevent the reaction from occurring every time the food is ingested. For example, if you have lactose intolerance, you may take lactase enzyme pills (ie Lactaid) to aid digestion. Also, symptoms of intolerance may be dose dependent. For example, a person with lactose intolerance may be able to drink milk in coffee or eat a small amount of cheese, but become sick when they drink full glasses of milk or eat a ball of fresh mozzarella. An individual with a food allergy, however, is likely to have a reaction when ingesting even the smallest amount of their allergen.

Diagnosing Food Intolerances

It is difficult to diagnose food intolerances. Similar tests used to diagnose allergies (skin prick, patch) are used. The most common intolerance, lactose intolerance, can be diagnosed through a hydrogen breath test or blood glucose test. However, all of the tests for intolerances are known to result in false positives and/or false negatives, and must be considered along with patient reported symptoms (which can also, naturally, result in false positives and false negatives). Conducting an oral food challenge for intolerances is not usually possible. Unlike food allergies, signs of intolerances can be very delayed or may not be directly observable (e.g. headaches).

Celiac Disease

Celiac Disease is a serious autoimmune disorder where the ingestion of gluten (a protein found in wheat, barely, and rye) leads to small intestine damage that can cause harmful side effects like malabsorption and extreme weight loss.

Diagnosing Celiac Disease

Celiac Disease is also difficult to diagnose. The gold standard is that if an individual is showing signs of significant weight loss, malabsorption, and/or recurrent GI issues while eating gluten, two types of blood tests are run: one to detect if certain autoantibodies are present in the blood, and another to determine if a certain genetic component is present. After that, an endoscopy is conducted to view images of the small intestine and contract a biopsy to study further in a lab. Even though there are more standard procedures for diagnosing Celiac Disease than there are for other food intolerances, it is still difficult to confirm diagnosis. The blood tests, and even the endoscopic tests, can be inaccurate and individuals often need to repeat tests and continue noting how their body responds to regular intake of gluten. The important things to remember with Celiac Disease, though, is that only 1 in 100 individuals are affected by it (rare), and that there is a strong genetic correlation (so those who lack the genetic marker are unlikely to have Celiac Disease),

Intuitive Eating, With Any of These Conditions

I have lived with allergies to peanuts for over 20 years. But it wasn’t until just two years ago that I learned I am also highly allergic to wheat and oat. Throughout college, I experienced persistent rashes, GI issues, and, most importantly, over 5 episodes of anaphylaxis that I could not clearly attribute to peanuts. Once I stopped listening to people who told me it had to be all “in my head” or that I wasn’t being “careful enough” to avoid my known allergens, peanuts, I saw two allergists (MDs), three gastroenterologists (also MDs), and two Registered Dietitians. Based on blood tests, skin-prick tests, patch tests, oral tolerance challenges, and scopes - they all ended up recommending that I eliminate wheat and oat from my diet.

I saw multiple doctors and repeated the same tests multiple times, because I wanted to be absolutely sure that I needed to eliminate these ingredients from my diet. At the time, I was fully recovered from the diet mentality and fully embracing the principles of Health at Every Size (™)  and Intuitive Eating. I was afraid that I might slip back into a disordered mindset if I “banned” all products containing wheat and oat from my meals. However, I soon learned that when you truly practice the principles of Intuitive Eating, it is unlikely that you’ll slip into a disordered mindset. I have not been eating peanuts (along with tree nuts as a precaution), wheat, or oat for nearly two years now and I have continued to practice the 10 Principles of Intuitive Eating. Here’s how I have made it work for me:

Principle 1: Reject the Diet Mentality

I always keep in mind that “reject the diet mentality” does NOT mean reject the practice of following a specific diet (or pattern of eating). “Reject the diet mentality” means rejecting the idea that your worth is tied to your weight, what you eat, and how often you exercise. Following a specific pattern of eating is necessary for some people. My reason for placing specific parameters on my diet is not because I want to lose weight or because I think it might make me a “better” or worthier person. Further, there are ways to reject the diet mentality beyond how you eat. Despite having dietary “restrictions,” I have completely eliminated the influence of diet culture from my life – I do not follow Instagram accounts that worship thinness and “being in shape,” I do not attend fitness classes explicitly centered on “burning” or “sculpting,” I do not use my weight as a marker of my health or wellbeing, etc.

Principles 2 + 5: Honor Your Hunger and Respect Your Fullness

These principles can get tricky to follow if I do not have allergen-free foods available to me. Most convenience stores and vending machines do not carry snacks that are safe for me to eat. Therefore, I have had to make a habit of I carrying allergen-free, non-perishable snacks in my backpack or pockets at all times (seeds, popcorn, chocolate, and occasionally something from an allergy-free brand like Enjoy Life foods). The snacks I carry with me have protein, carbs, and fat in them (that is: not just an apple). If a meal is not immediately available to me, I can still honor my hunger whenever I need to with one of these quick snacks. The snacks help me avoid becoming ravenous, prevent the drive to overeat at meals, and ultimately allow me to respect both my hunger and fullness cues.

Principles 3 + 4: Make Peace with Food + Challenge the Food Police

When there are already so many foods that are not safe for me to eat, it is especially important to ignore “food rules” that diet culture has created (e.g. “eat foods that have as few ingredients as possible.”). I give myself permission to eat whatever foods are safe for me to eat. I keep multiple kinds of allergen-free breads, pizzas, and ice creams in my freezer, so that I can honor any of my cravings at any time.

Principle 6: Discover the Satisfaction Factor

When I first eliminated wheat from my diet, I thought I might never feel satisfied without bread. But what is interesting about a true food allergy (versus a dietary restriction imposed for completely arbitrary reasons) is that you usually do not crave your allergens. I am perfectly satisfied by the brands of gluten-free, nut-free breads I’ve found. My body associates my allergens with anaphylaxis. By listening to my body, and choosing other foods, I do get to a place where I am both full and satisfied.

8 + 10: Respect Your Body + Honor Your Health

By the time I was diagnosed with wheat and oat allergies, I truly already accepted my body shape and size for what it was. However, I then had to accept that my immune system attacks itself when I eat peanuts, wheat, and oat…and that there is no cure for this condition. I needed to decide that my body is worthy of respect exactly as it is, and that one of the ways to respect it is to not eat my allergens. Not eating the foods my immune system reacts to is also a way to honor my health. Further, I make Gentle Nutrition food choices by noticing what meals make me feel energized and satiated. I accept that not all of my meals have to be “perfect,” but also that I need to get enough calories, macronutrients (carbohydrates, fats, and protein), and micronutrients (vitamins and minerals) to feel well.

Do you practice intuitive eating with a condition like food allergy or intolerance? Let us know in a comment below. It is critical to have conversations about how the practice of intuitive eating can coexist with a medically prescribed diet.

Do you believe you may have a food allergy or intolerance, but are not sure? It is critical to see an MD that is a Board-Certified Allergist. Dietitians are not able to test for food allergies, and gastroenterologists will only focus on allergies/intolerances with GI-related symptoms.

There are online resources that support the idea of self-diagnosing allergies and intolerances, but it is critical to see a doctor to get comprehensive testing and appropriate medications (such as EpiPen) if you do have a true allergy.