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Nutrition

Focusing on YOU with a food related diagnosis

by Valerie Polley | Jan 17, 2019 | 0 comments

Many of my clients comment that co-workers, friends and even sometimes family are not understanding of their diagnosis or why they are eating a certain way. It is difficult to be in social settings with food and feel like you aren't eating like everyone else, or able to eat anything at all. I reached out to a licensed mental health counselor, Denise Cutshaw to get her opinion on how individuals can deal with outside pressure when given a diagnosis that effects the foods they can eat. Enjoy! And at the end of her blog are a few extra questions I had for her.

Whether you, or a loved one such as your spouse, child or other family member has been recently diagnosed with any type of gastrointestinal issue, food allergy or intolerance, it can feel very overwhelming. You start with educating yourself on the types of foods that are “safe” and may even reach out to a registered dietitian to help you with a food plan (highly recommended!).

Then…the feelings set in as you begin to navigate through get togethers, parties, celebrations, holidays, office breakfasts/lunches, and traveling. Common feelings that may arise are loneliness, isolation, feeling misunderstood, frustration, anger, defeat, anxiety or even depression. If these feelings are persistent for you, it may be beneficial to talk with a counselor. Counseling can help someone with a recent food allergy/intolerance or autoimmune diagnosis, such as celiac, better cope with these feelings and how to ask for help and support from loved ones and friends. Children can especially find benefit in talking with a counselor and seeking out support groups to help normalize their feelings by being exposed to others with similar circumstances.

Counseling can help an individual process and work through some of these feelings through different modalities of treatment. Cognitive Behavioral Therapy is extremely beneficial in identifying one’s thoughts, feelings, and behaviors as it relates to food and outings with food. Assertiveness skills can be taught and reviewed as a means of making sure you build a safety net around your core people that are aware of restrictions and are sensitive to your needs or the needs of your child. Thirdly, psychoeducation can be provided through the counseling relationship as well as with your dietitian on acquiring knowledge and education on your limitations/diagnosis.

Life transitions and events can certainly contribute to an onset of depression and/or anxiety. When to be concerned or seek out help for depression and/or anxiety symptoms depend on a multitude of factors. Consider these presenting factors for depression and seek counseling to help address these:
1- Depressed mood most of the day (in children and adolescents, they can present as irritable and/or withdrawn
2- Diminished interest in pleasurable activities
3- Weight loss (specific to lack of appetite)
4- Sleeping too much or too little
5- Fatigue or loss of energy
6- Feelings of worthlessness
7- Difficulty concentrating that affect completion of tasks
8- Suicidal thoughts

- These symptoms cause significant impairment in one’s ability to function socially and/or occupationally. Symptoms persist for 2 weeks or more.

Consider these presenting factors for various types of anxiety and seek counseling to help address these:
1- Excessive anxiety and worry about events and activities (such as work or school performance)
2- Difficulty controlling the worry
3- Restlessness, feeling keyed up or on edge
4- Being easily fatigued
5- Difficulty concentrating or mind going blank
6- Irritability
7- Muscle tension
8- Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)

​- These symptoms cause significant impairment in one’s ability to function socially and/or occupationally. Symptoms present more days than not in the past 6 months.
- Another aspect that may be affected is social interactions. Consider these presenting factors for social anxiety and seek counseling to help address these:

1- Fear or anxiety specific to social settings, in which a person feels noticed, observed, or scrutinized. (In children, the phobic/avoidant behaviors must occur in settings with peers, rather than adult interactions, and will be expressed in terms of age appropriate distress, such as cringing, crying, or otherwise displaying obvious fear or discomfort).
2- Fear of being anxious or having anxiety symptoms in front of others
3- Social interaction will consistently provoke distress and therefore avoided.

- These symptoms cause significant impairment in one’s ability to function socially and/or occupationally. Symptoms present more days than not in the past 6 months.
- In conclusion, whether it’s you, a friend, family member or a child, counseling can really help address these feelings and provide coping skills and tools to manage these symptoms. The best place to begin is to contact your insurance company as they can help assist in locating a counselor that is convenient to you, accepting new patients, and has experience in the areas you wish to address. Contact your member services number on the back of your card and ask for behavioral health outpatient counseling. Another helpful tool is a website www.psychologytoday.com. There you can search therapists, locations and specialties. If you do not have insurance, many counselors will work with you on a sliding scale fee. Help is available and you are definitely not alone!

Questions for Denise:
Question: How should patients/clients deal with co-workers, friends, etc. that continue to make comments about what they are or aren't eating? Even adults can somewhat "bully" another adult and make them uncomfortable in social situations with food. Often times these individuals avoid situations that involve food because it is uncomfortable, especially around those that don't understand. This comes up with a handful of clients and it is easy for me to tell them to tell their co-workers it is a doctor's order, but this doesn't always make the situation better.

Answer: It's hard to deal with people that don't understand and make comments about food whether they are rude comments or bringing attention to it. Some ways to manage that is to be as educated as you can be on what foods are "ok" for you and why so you can respond with "I've learned so much about what works for me" or "it was a little difficult for me too at first to understand, but I've really educated myself and found what works and it is helping tremendously".

When loved ones that we are very close to continue to make comments, using "I feel" language is also helpful. For example. "When you make comments about my food, it makes me feel anxious and on edge. I need for you to be understanding of my food choices and not make those comments". That type of language allows an openness about how the comments make you feel and if the person is still unable to honor your needs, you can then decide to restrict your time with them, especially around food. You can also invite close loved ones with you to a dietitian or doctor appt. to assist in education on the matter so they have a better understanding.

Question: Do you encourage a significant other (if the person with the diagnosis is an adult) to join them for these professional visits, such as with the dietitian or yourself? Some family members are not supportive, so do you think it helps to have them present or hurt? I see this with individuals that have been dealing with these GI issues for a long time.

Answer: As a counselor, I truly feel that getting as many people involved in your care is so very important. It can assist in the person's support network with education but also insight into the feelings of the person affected and how these food issues impact them on a daily basis. For children, any caregiver that will be caring for the child and feeding them meals or snacks would benefit from attending any appointments as well. Even the parents of friends of your child can be educated and provided a "safe list" of snacks and foods okay to eat while your child is over at their home playing. This helps reduce any potential anxiety for the parent or child and the child doesn't feel "singled out" having to sit out for snacks during play times.

Overall, being assertive and open is always best in the care for yourself or your loved ones who struggle with food issues. If you're finding you're avoiding situations around food either yourself or your child, it could be an indication you may need to be more open and assertive about your needs or the need of your child as well as your feelings so people can better understand and be educated.

Denise Cumshaw, LMHC is on leave at this time and not accepting new patients, but if you need more information or feel like you may benefit from counseling services please contact her at dmcutshaw.lmhc@gmail.com.

"Processed food" has become a catch-all term for foods we're told to avoid, but food processing isn't automatically a bad thing.

Technically, many foods you probably enjoy regularly are processed. Frozen vegetables, canned beans, yogurt, nut butter, and whole-grain bread have all been changed from their original state in some way.

So when research links processed foods to certain health concerns, it's important to understand what kind of processing we're talking about.

Much of the recent research has focused specifically on ultra-processed foods (UPFs). Diets containing large amounts of these foods have been linked to a range of negative health outcomes, including digestive and metabolic health issues, inflammation, and heart disease.

This article will review what we know so far and give you tips for including more whole foods in your diet.

Processed vs. Ultra-Processed Foods: Understanding the Difference

In food and nutrition research, a system called the NOVA classification is often used to group foods according to the type and extent of processing they undergo.

Minimally processed foods include fruits, vegetables, eggs, milk, and plain grains that may have been washed, frozen, pasteurized, dried, or otherwise prepared without significantly changing them from their original state.

Processed foods are generally made by adding ingredients such as salt, sugar, or oil. Examples include canned vegetables, cheeses, or freshly made breads.

Finally, ultra-processed foods are industrial formulations containing ingredients or additives not typically used in home cooking. Examples include many sodas, packaged snacks, instant noodles, candies, and some ready-to-eat meals.

This distinction is important because simply avoiding all processed foods would mean missing out on many convenient and nutritious options (such as canned beans and vegetables).

It's also important to recognize that there's considerable variation among foods categorized as UPFs. For example, a packaged whole-grain bread and a soda may both meet the criteria for ultra-processing under the NOVA classification, despite having very different nutritional profiles. 

Instead of deciding not to eat a food simply because it's processed, it can be more useful to look at the bigger picture and consider what nutrients the food provides and how it fits into your overall diet.

How Can Ultra-Processed Foods Affect Digestion?

While we're still uncovering exactly how UPFs affect the digestive system, one possibility is that they lack fiber.

Some diets high in UPFs are lower in naturally fiber-rich foods like fruits, vegetables, whole grains, beans, lentils, nuts, and seeds. You probably know fiber is important for staying regular, but certain types of fiber (known as prebiotics) act as food for the beneficial bacteria living in your gut. A diet lower in fiber may therefore affect both digestion and the health of your gut microbiome. 

There's also research currently examining the effects of common additives found in UPFs, such as certain emulsifiers and artificial sweeteners. However, most of the research linking these additives to negative effects on the gut microbiome and intestinal barrier has been conducted in vitro (test tube) or animal studies, so more research is needed before we can confirm whether these additives are harmful in humans.

Finally, some studies have found links between UPF intake and certain gut conditions. For example, a large systematic review and meta-analysis found that higher UPF consumption was associated with an increased risk of developing Crohn's disease.

However, there's still a lot we don't know about how UPFs impact gut health, and more research in humans is needed to understand which food components or other dietary factors may be responsible.

UPFs and Inflammation

Chronic, low-grade inflammation has been linked to the development of several chronic diseases, prompting researchers to investigate whether diets high in UPFs could contribute to inflammation.

Here are a few possible explanations:

  • A diet high in UPFs may contain fewer foods rich in fiber, vitamins, minerals, and phytochemicals, which are associated with better overall diet quality.
  • A diet high in UPFs can also contribute significant amounts of refined carbohydrates, saturated and trans fats, sodium, or added sugars.
  • Certain ingredients in UPFs may alter the gut microbiome and promote gut inflammation.

However, much of the evidence connecting UPF intake with inflammation and chronic disease is observational. Studies like these can identify patterns, but they can't always tell us whether UPFs specifically are responsible or whether other differences in diet and lifestyle contribute to the association.

UPFs and Overall Health

The research on UPFs becomes more conclusive when we zoom out to consider overall health.

A 2024 umbrella review published in The BMJ found that higher exposure to UPFs was linked with increased risk across several health outcomes, with some of the strongest evidence involving heart disease, type 2 diabetes, mental health outcomes, and overall death rates.

However, it's important to note that the quality of the studies included in the review varied considerably. Only four of the 45 studies they reviewed received a moderate-quality rating; most were rated low or very low quality.

That said, there is some experimental evidence to consider. A small but well-controlled study of 20 adults found that those eating UPFs consumed an average of 500 additional calories per day and gained about 2 pounds. They lost a similar amount of weight when eating the minimally processed diet. The study showed that something about the UPF dietary pattern encouraged greater calorie intake, but it couldn't identify exactly which UPF component was responsible.

Do You Need to Stop Eating UPFs?

UPFs can provide valuable nutrients, and all foods classified as UPFs are not nutritionally identical. Instead of trying to eliminate all foods that qualify as UPFs, consider your overall dietary pattern. For example:

  • Are you including fruits and vegetables throughout the day (fresh, frozen, or canned)
  • Are you choosing whole grains and other fiber-rich foods regularly?
  • Do you include beans, lentils, nuts, and seeds in your diet?
  • Do you compare packaged foods based on what nutrients they actually provide rather than assuming that processing alone determines their nutritional value?
  • Do you use convenience foods like canned beans and vegetables to make balanced meals easier, rather than feeling overwhelmed trying to prepare everything from scratch?

If UPFs currently make up a large portion of your diet, you don't need to overhaul everything overnight. Instead, try adding more minimally processed, nutrient-dense foods alongside the foods you already enjoy.

The Bottom Line

Food processing exists on a spectrum, and processed doesn't automatically mean unhealthy.

Research suggests that diets high in UPFs are associated with several health concerns, but researchers are still working to determine why these associations exist and whether all foods classified as UPFs carry the same risks.

Rather than fearing individual foods, focus on your overall dietary pattern. A diet built around a variety of fiber-rich plant foods, adequate protein, and nutrient-dense choices can still leave room for the occasional UPFs.

If you need help incorporating more whole foods into your diet, a dietitian can help. Click here to book an appointment with us at Blue Tree Nutrition.

 

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Hello, I am

Valerie

My name is Valerie Polley. I am a Indianapolis-based registered dietitian and owner of Blue Tree Nutrition. I consult with clients both local and far away.
I have a bachelor’s degree in nutrition from Purdue University and I have been practicing for 20 years.
I thoroughly enjoy helping clients through their gut health journey. I see a range of GI issues including, but not limited to celiac disease, IBS and SIBO. I also specialize in the FODMAP elimination diet.

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