“How do I start reintroducing foods that I’ve eliminated without triggering a flare?”
It’s a great question and one that my community has asked me repeatedly to address. The problem is that by blaming diet over and over — food fear is created.
And let me tell you from personal experience — food fear is very real (and awful).
Because your skin is like a sponge and requires so many nutrients, increasingly restrictive elimination diets can put you on the path to nutrient deficiencies.
And make you more socially withdrawn and food obsessive. Many can feel like a victim of food and like a constant failure (because you aren’t being strict enough).
I’d like to offer a very different perspective on food fear. So let’s breakdown how many are ending up with food fear and some practical steps to start walking yourself out of this food restriction hole!
Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android
In this episode:
- How you end up with food fear from eliminating food from your diet
- What happened when Jodi solely blamed food for her rashes
- What if it’s not food that’s triggering rashes (but something else)?
- Are food sensitivity tests helpful (or cause more harm)?
- My recommendations to begin reintroducing foods
Quotes:
Thinking that diet is the only thing you can change to improve your skin is a very dangerous and shortsighted idea.
The book industry has focused so much on empowering people around elimination diets that it has inadvertently misled them to believe that the thing that will fix their skin is food. And that ultimately food is the enemy.
Overcoming Food Fear Triggering Skin Rashes (FULL TRANSCRIPT)
Welcome back to episode #89 of the Healthy Skin Show!
In today's episode, I want to talk about how to overcome food fear. I'd like to focus specifically the fear you may experience when considering the reintroduction of foods that you believe are skin triggers.
It's not uncommon to eliminate a bunch of different foods that land you on a very restrictive (and at times unnecessary) elimination diet.
While elimination diets exist for eczema and psoriasis (and others used for autoimmune conditions), it might not be the best move for you. Blindly following what your fellow skin rash warriors do won't guarantee you results.
I totally get that the recommendation and use of these diets is well-intentioned. But there can be a serious drawbacks that no one tells you… one of which is developing food fear.
Before I talk about how to begin undoing this type of disordered eating (also known as Orthorhexia), we've got to be clear on how we got here in the first place.
And make no mistake, it can be very difficult to undo food fear. It's not impossible, but it takes time (and may require guidance and support to do so).
How Do You End Up With Food Fear In The First Place?
So how do you end up being so afraid of food?
To illustrate exactly how people in our community end up with food fear, I'd like to share one of the many client stories where I have personally witnessed this first-hand.
I worked with one woman (we'll call her Jodi) who developed a lot of skin rash issues. At some point, she decided to go on a fairly popular autoimmune-type elimination diet that was recommended to her a bunch of people online.
She figured it couldn't hurt and didn't have anything to lose since she wasn't getting any results from her dermatologist.
As a result of the elimination diet, Jodi saw a huge improvement in her skin. Of course she was thrilled!
With time, she found that she wasn't able to sustain the diet because it wasn't practical for her life and hectic travel schedule.
Eventually all of her symptoms came back and she felt even worse than before.
After some time, Jodi psyched herself back up to start the diet again.
Except this time, she didn't get better.
If anything, she got worse. As she researched more online, she started to think that other foods MUST be to blame.
Little by little, she took out more foods making an already restrictive elimination diet smaller and less diverse.
By the time that we sat down to meet for a consult, she was eating the same five foods every single day.
She felt horrible as she dragged herself exhausted through her day. Her skin was a mess and she had put on lots of weight.
What most frightening to her was how helpless and lost she felt. She wanted help, but didn't know what to believe anymore after all her research online.
Any mention of reintroducing foods was met with resistance.
She just didn't want to add anything back in that would flare her skin.
At one point, we came to an impasse. She would rather stay on a really limited diet to avoid a potential flare even though her skin wasn't doing all that great to begin with.
Food Is Not Your Skin’s Enemy
Jodi's story is a pretty common one in my practice clinical nutrition practice.
And it's also very common to see well-intentioned diet recommendations made between members of Facebook groups desperately seeking answers to their skin.
They become so frustrated with the lack of help from their doctor that they buy into the idea that the only thing left to control is diet.
I want to be honest here… thinking that diet is the only thing you can change to improve your skin is a very dangerous and shortsighted idea.
And I am very sorry for anyone who has read all of these skin diet books thinking that that's all you can control. Those ideas have landed some of my clients and community members in the hospital incredibly malnourished.
I share this so that you will hear this message from at least ME — there is a lot more that you can control than just food.
The book industry has focused on publishing books penned by functional medicine experts that empower people around these different elimination diets.
As a result, it has inadvertently misled people to believe that the only thing likely to fix their skin are food eliminations. It essentially positions food as the enemy.
But think about it for a second…
How awful is it that we are turning people against nourishment?
Instead of encouraging you to seek out your own combination of root causes triggering your skin problems, your told that food is all that you can control.
No good can come from creating an enemy out of something that is so deeply personal and important for your wellbeing.
Because food is not your enemy.
And you aren’t a failure because you can’t stick to a super restrictive elimination diet.
I'm not saying that there isn't a time and a place for an elimination diet, but most are being done inappropriately. They’re either recommended for too long or they’re downright too restrictive without appropriate guidance from a professional.
Getting proper nutrition is not a luxury. Biodiversity in your diet is critical to your health as well as to the health and diversity of your gut flora.
What If Your Skin Reactions Aren’t Because Of What You Ate?
I hope that what I’ve shared so far will give you pause so that you think twice before diving headfirst into an elimination diet.
And if you've been on one for a really long time and now you’re afraid to add foods back in because they could trigger a flare… where can you start?
Before I answered this question, I want you to know that I know what it's like to live with food fear.
In 2008, I ate some egg salad made with chicken eggs. I got so sick from it that I thought that I was having a heart attack and almost drove myself to the hospital.
Fortunately, I wasn’t, but I did end up violently ill in the bathroom. (No, it wasn’t food poisoning.)
It turned out that I had a very severe reaction to chicken eggs. From that moment forward, I was terrified to eat chicken eggs again.
In 2014, I met the great Dr. Terry Wahls who recommended that I try duck eggs since it’s a different protein.
Believe it or not, it took me five years to build up the courage to try duck eggs because of how traumatized I was from that egg salad incident.
I was so worried that I was going to get sick and prepared to spend all day in the bathroom again. Turns out, that I can eat duck eggs without any reaction!
The point here is that food fear is VERY real.
But here's the thing…
What if it's not about the food that you're eating that's triggering a flair, but instead what happens to the food you’ve eaten interacting with your gut (and the microbiome that lives there)?
What’s going on in your digestive tract can drive inflammation and trigger your skin by spilling over and causing a burden that’s pushed out through your skin.
It means that food eliminations aren’t the solution… they’re only a bandaid.
Take a moment to let that sink in.
This is one of the biggest missing pieces of the equation! You won’t find this point made in diet books or from someone sharing a recommendation online.
What About Food Sensitivity Tests?
By taking out too much food, you can become nutrient depleted.
Aside from that physiologic effect, elimination diets can make you socially unhappy and deeply fearful of eating. You can also feel very isolated and resentful.
Some have more recently argued that elimination diets can lead to loss of oral tolerance to foods that were unnecessarily eliminated. So the process of eliminating foods could make things even worse!
I know what you're thinking, “Jen… I had a food sensitivity test done and it came back with like 25 things on it that I can't eat.”
Food sensitivity testing is pretty inaccurate and can be all over the place.
Depending on the state of your gut (and how leaky it is), your results can shift and change at any given time. So tests taken a month (or three months) apart could result in very different answers that make you want to scream.
Plus, food sensitivity testing can result in false negatives. This means that if you've already eliminated specific foods for some time, your test might say that you can eat them because there aren't enough IgG antibodies hanging around. If you were to eat those foods before the test, the panel might look much different.
And for what it's worth, food sensitivity tests performed on a snip of hair are worthless — save your money.
Lastly, another issue exists around how we put into action the results that the test gives us. One common problem is assuming that even MILD reactions must be eliminated which ultimately results in over-restriction.
Mild reactions on a food sensitivity panel (assuming it's accurate) are generally reflective of foods that you eat. Moderate and Severe reactions are more significant.
But again… food sensitivity (or food intolerance) testing is really suspect and I rarely use it anymore in my practice.
How To Overcome Food Fear & Start Reintroducing Foods
Before you start adding foods back in, consider why you removed the foods that you did in the first place.
Did they actually trigger symptoms?
And did you see an improvement after removing this one food?
Was it a specific food that a doctor (or nutritionist or dietician) that you're working with told you to remove?
Or was this a recommendation of a random person online who unfortunately doesn't know you at all? Or something you found in a book?
If you've seen no real improvement from eliminating certain foods, then those would likely be the foods to begin adding back in (of course, minus gluten since it is the one food that can increase gut permeability).
I recommend adding one food in at a time over the course of three to four days. Give space between each food introduction so you can tell whether you're having a reaction to it or not.
You may also want to start with low FODMAP foods first, instead of something like beans and whole grains (like brown rice) since they can be trickier to reintroduce.
If you seem to react to animal protein sources or don't really crave animal protein sources, I would highly recommend that you do the low stomach acid test.
It is highly common to have insufficient stomach acid when you've got a bunch of health issues going on.
When clients say something like…
- “my skin got better after I took meat out“
- “I just don't crave meat“
- “I only eat very little portions. I just don't seem to want it.”
Nine out of 10 times, they don't have enough stomach acid.
This is a big deal because if you aren't producing enough stomach acid, you're likely not getting access to the nutrition that you eat. AND you open yourself up to potential gut infections since your stomach acid is also a chemical barrier to stop bugs that you inhale or swallow.
This is by no means an invitation to reintroduce super processed foods that have a laundry list of ingredients. If you're used to eating a highly refined processed junk food-filled diet, it's time to let that go and embrace a diet that focuses more on real food.
And last but not least, you might actually need help.
If you find that the reintroductions aren't going well, it's time to get a partner on your side to help you. It's not uncommon to have unlying problems that need to be resolved before reintroductions will be successful.
And lastly, support can be critical especially when your life is ruled by this type of disordered eating pattern. Orthorexia is a form of disordered eating that is so incredibly prevalent now in the chronic illness community as a result of over-emphasizing and over-pushing elimination diets as the only solution available to you.
Support can be crucial!
Many of my clients come to me with food fear only to discover that it wasn't the food that was causing the problem.
It was other root causes under the surface, some of which I've discussed here. One person thought it was really crazy that he was able to eat all of these foods! For so long, he had bought into the idea that that was food making him sick and flaring his skin.
In reality, there were other things going on underneath that were the real issues that need addressing.
Is There Hope To Recover From Food Fear?
Remember that there are 16 different root causes that can trigger skin problems. This means that you have way more control over this whole skin rash puzzle of yours than you think.
Food is not the only variable that you can control and take action. And that's why it shouldn't be the only thing that you should focus all of your energy on.
Don't mistake me — food is certainly an important piece of the puzzle.
Now, it's a totally different matter if you have a legitimate food allergy or some sort of intolerance (like lactose or histamine intolerance).
Allergies can be life-threatening while an intolerance happens when your body doesn't make a specific enzyme to break down a particular food. They are NOT the same as a food sensitivity.
(NOTE: These 3 phrases — allergy, sensitivity and intolerance — are not all the same thing and should not be used interchangeably.)
So is there hope to get over your food fear and finally incorporating more foods into your diet?
Heck yeah, there totally is!
It often doesn't happen overnight. It takes some patience.
And if you find that you're stuck, get some help.
If you've got any questions or an experience you'd love to share, leave your comments below!
And last but not least, if you know that someone is really struggling with food fear and they don't know what to do, share this with them.
I want to thank you so much for tuning in today, and I'll see you in the next episode!
